Denial of coverage
Denial of coverage
My husband went in for a sleep study and was told he has sleep apnea. We got a CPAP machine because it was the recommended treatment. He was using the machine and things were going good. The machine then started acting up and waking him up at night because the blowing pressure would choke him; it was so loud it would wake me up. He ended up taking it off at that point because it wouldn't stop. He did keep trying to use it. He called several times and was told by a nurse that he just has to get used to it, that it was fine. After our trial period of 3 months with the machine he was told he didn't use it enough for insurance to cover the machine anymore (4 hours every night). They then stuck us with a bill for $1,000 for a CPAP that cost $700 to buy outright online and the insurance has paid on for 3 months already. Then we appealed to the insurance stating we need more time, explaining he was trying to use it but not getting help figuring out the issue with the machine. The appeal was denied saying his CPAP is not medically necessary! Why were we told he needs a CPAP if it isn't medically necessary? What grounds does insurance have to tell him it's medically unnecessary when his doctor told him to get it because he has sleep apnea? How can we fight this? I want to request a review of the denied appeal but I want to make sure I understand all this. Thank you for any advice
submitted by /u/Necessary_Tension461
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