Sleep apnea is a serious sleep disorder that happens when your breathing stops and starts during sleep. When left untreated, sleep apnea can cause extremely loud snoring, exhaustion during the daytime hours, and more serious issues like high blood pressure, stroke, diabetes, kidney disease, dementia, cancer, and other heart issues.
Sleep apnea is not the same as “regular” snoring, which can be caused by sleep style, being overweight, or nose and throat conditions. While sleep apnea, in and of itself, is unlikely to be fatal, those who have the condition have twice the risk of dying suddenly if the condition is not treated. This is because untreated sleep apnea is linked to the more serious conditions listed above.
If you have received a sleep apnea treatment insurance denial, not only is it discouraging, but it can be downright dangerous when you do not receive a treatment that can significantly improve your health. Having an experienced insurance denial lawyer like attorney Scott Glovsky can vastly improve your chances of having an insurance denial reversed.
What Are the Symptoms and Causes of Sleep Apnea?
Symptoms of sleep apnea include snoring much louder than those with “regular” snoring, pausing breathing for ten seconds or more, being more restless during sleep, and often taking shallow breaths, gasping, or choking while sleeping. The causes of sleep apnea can include:
- Obesity
- Chronic nasal congestion
- Narrowed airways
- Diabetes
- Smoking
- Endocrine disorders
- Heart or kidney failure
- Hormone disorders
- Hypothyroidism
- Metabolic disorders
- Neuromuscular disease
What Are the Common Treatments for Sleep Apnea
The treatment for your sleep apnea may depend on the underlying cause of the apnea. If your doctor believes obesity or diabetes may be causing your sleep apnea, you may be prescribed a diabetes/weight loss drug like Mounjaro, Saxenda, Wegovy, or Ozempic. Since these drugs are fairly expensive, your insurer may deny the treatment. These drugs may also address the risk of cardiovascular disease and non-alcoholic fatty liver disease as they relate to your sleep apnea. Other treatments for sleep apnea include:
- Surgery
- ASV machines
- CPAP
- Tonsillectomy
- Hypoglossal nerve implant
- Bariatric surgery
An ASV machine can cost upwards of $3,000, while a CPAP machine can cost between $1,000 and $2,000. A hypoglossal nerve stimulator can cost between $30,000 and $40,000, and bariatric surgery costs range from $7,500 to $33,000. As you can see, many of the treatments for sleep apnea can be pricey, leading an insurer to deny the treatment.
Why Might You Receive a Sleep Apnea Treatment Insurance Denial?
To determine why you received a sleep apnea treatment insurance denial, you should carefully read the letter you received that explains the denial. In some cases, the denial could be due to a relatively simple issue associated with the claim itself. If so, any errors can be fixed, and additional documentation provided.
Other times, your insurance company may deny treatment by saying it is “not medically necessary,” “investigational,” or “experimental.” This often translates into “too expensive.” Despite the fact that you have faithfully paid your monthly insurance premiums, insurance companies are focused on their financial bottom line. This leads insurers to deny many treatments that are expensive.
What Should You Do if You Receive an Insurance Denial for a Sleep Apnea Treatment?
If you have received a sleep apnea treatment insurance denial and you do not know what to do, the Law Offices of Scott Glovsky can help. We can assist you to file an internal appeal, asking your insurer to reconsider its decision. A letter from your doctor detailing why you need the treatment is typically a part of this appeal. If your insurer continues to deny your sleep apnea treatment, your attorney may counsel you to file an external appeal which will be heard by a neutral third party. If the external appeal is in your favor, your insurer will be bound by the decision. But depending on your specific type of health insurance, your attorney may suggest taking legal action instead of filing an external appeal. That’s why speaking with an experienced health insurance denial attorney is essential.
Which Insurers Are More Likely to Deny Sleep Apnea Treatments?
Although any insurer can potentially deny sleep apnea treatments, some are more likely to do so than others. The primary insurers for those in California include:
How the Law Offices of Scott Glovsky Can Help with Your Sleep Apnea Treatment Insurance Denial
At the Law Offices of Scott Glovsky, our cases have impacted millions of insurance policyholders by forcing insurance companies to change their behavior, including reviewing requests for medically necessary treatments. While it can be disheartening to have medical treatment denied by your insurer, you do not need a legion of lawyers to fight back. You only need one person who cares enough about you to fight a big insurance company on your behalf. Do not wait – contact the Law Offices of Scott Glovsky today.