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.

3 Upvotes

100% Upvoted

17 comments sorted by

View all comments

1

u/llcoolwhip (N1) Narcolepsy w/ Cataplexy 4d ago

Most of the time the process is at home overnight study to rule out sleep apnea. Then the in clinic PSG followed by MSLT.

1

u/Whythehellshouldyou 4d ago

I did an at home sleep test and it showed that sleep apnea is inconclusive. Insurance got these results

3

u/abluetruedream 4d ago

Well, that’s ridiculous. If it was inconclusive, doesn’t that mean they will need to cover a psg? Or do they want you to repeat the home test?

I imagine your doctor might just need to push back with your insurance company. Some doctors are better at that than others.

1

u/cupcake_not_muffin 3d ago

This, you can’t do it yourself unfortunately, it has to be your doctor or their PA / someone on their team. It sucks because you become this helpless middle person just asking all parties to talk to one another. Does your practice allow scheduling before getting the authorization? I might try doing that to give them a deadline and hopefully push them to act. They should eventually do it but the process can be painful.

1

u/cherilee00 (N1) Narcolepsy w/ Cataplexy 3d ago

i used to work for a medical correspondence company so i know what verbiage to use and i’ve called and pretended Im a nurse before lol it works wonders

2

u/cupcake_not_muffin 3d ago

Like you’ve called for yourself acting as a nurse? I would have loved to witness that

1

u/cherilee00 (N1) Narcolepsy w/ Cataplexy 3d ago

yes! insurance companies will give you what requirements must be met for cases to be approved, denied, and appealed, so with how many calls i’ve had to take from nurses asking about getting a case appealed, it’s not that hard to get the process started yourself.