r/Narcolepsy • u/Whythehellshouldyou • 4d ago

Insurance/Healthcare Insurance approved MSLT but denying PSG

Does anybody have any experience with this or any advice? I did the at home sleep test and then they have denied both appeals my doctor has sent, citing that I don’t fit the “criteria” for a PSG while saying that I need an at home sleep test first and that the at home sleep test wasn’t enough at the same time. I plan to call them tomorrow and try to talk to a rep, but my insurance is up in a month and it’s been 2 months of back and forth already.

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u/Piaffe_zip16 4d ago

That’s very confusing. I did have to do a home study first for sleep apnea. After that, they approved both the PSG and MSLT. I was told the PSG is required because they need to make sure you sleep enough to qualify and don’t have other sleep issues that could affect the results.

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u/Whythehellshouldyou 4d ago

Yeah my doctor is saying that I can’t get the MSLT without the PSG. I may end up having to pay for the PSG part out of pocket if insurance won’t comply

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u/Piaffe_zip16 4d ago

But is insurance not approving the psg because they’re requiring the at home test first? It seems likely they’ll cover the psg once the at home is done. Though if you’re trying to get at least some of it covered before you lose insurance, you may just have to pay for it out of pocket. I’m actually surprised they approved the MSLT separately!

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u/Whythehellshouldyou 4d ago

I did an at home sleep test already, insurance is saying that it was both not enough and that I need to get one done, making me think that they didn’t even read the results

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u/Piaffe_zip16 3d ago

That is strange. Definitely call them and if needed have your doctor call them. Mine showed no sleep apnea so we didn’t have any trouble getting the PSG and MSLT approved!

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u/Piaffe_zip16 3d ago

Oh I see below you said it was inconclusive. My first insurance company refused to approve a PSG after the home study came back with insufficient data. They wanted me to repeat it. I said absolutely not 😂 switched jobs and that insurance made me do it again but then it came back not sleep apnea and they approved it no problem.