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Irritated With New Insurance Company

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#1 supertired

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Posted 14 December 2013 - 11:12 PM

So I tried to get prior approval with my new company insurance plan.

 

I wanted to go see a nuerologist to get treatment.

 

The response I received after telling them it was for narcolepsy was that sleep disorders aren't covered by the policy.

 

I was shocked at the lack of knowledge of this "Advisor."  I had to politely explain to her that this is not a traditional "sleeping disorder" like sleep apnea or upper airway obstruction.  A simple consultation with a psychiatrist or nuerologist would inform them that this is a nuerological disorder.

 

 

I haven't received a response yet but has anyone ever had this misclassification of this disorder happen to them?



#2 browndog319

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Posted 15 December 2013 - 05:18 PM

I'm sure that that person is misinformed. Even not treating sleep apnea will result in heart attacks, high blood pressure, etc. So it actually is cheaper for an insurance company to cover a CPAP machine and supplies in the long run than the medications and events associated with the diseases that can result from untreated sleep apnea.

 

Can you call the insurance company back or go to your HR person and get a copy of your benefits plan? It should have what your exclusions are.



#3 supertired

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Posted 16 December 2013 - 01:56 AM

I've put those wheels in motion.

 

I do not like my employer knowing my condition.  now the genie is out of the bottle.



#4 Hank

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Posted 16 December 2013 - 08:51 AM

I've put those wheels in motion.

 

I do not like my employer knowing my condition.  now the genie is out of the bottle.

Was your conversation with your employer or the insurance plan. If it was with the insurance plan, they cannot discuss that under HIPAA regulations. Unless you have told your employer directly, they won't hear it from the insurance plan.  

 

I don't know what kind of job you have and what your employer is like. JAN (Job Accommodation Network) was a helpful resource for me to problem solve



#5 supertired

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Posted 17 December 2013 - 12:29 AM

I had to involve my company HR department, they administer the plan and decide the benefits.  It's a huge hassle.

 

I thought for once I'd have a good insurance policy since this is a company with 1,500 employees.  I had better coverage in the US and had to pay everything out of pocket except for medication.

 

Now it looks like I will have to pay everything out of pocket.  What's the purpose of medical coverage if basic needs aren't covered?

 

It's silly how this company brags about itself being sustainable, wins awards, is global, has large successful projects, etc. but has yet to meet an employee's basic medical needs in order to cut costs.  Do they think we are just robots?

 

I actually think I will be terminated for another "straw man" issue but this will be the actual cause.  It's shameful on the company's part.  It's not helping my attitude or job performance to be screwed over like this.



#6 IdiopathicHypersomniac

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Posted 17 December 2013 - 11:06 PM

Then you better go on temporary medical leave to protect your job.  They won't be able to fire you then.



#7 supertired

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Posted 19 December 2013 - 08:07 AM

3rd denial today.

 

The insurance company refused to site their source which defined narcolepsy as a sleep disorder related to the likes of snoring and sleep apnea.  He said his "medical team"  is "wholly trained" and don't need to site references.  I doubt he even spoke to them.

 

I kindly wrote him back detailing the orexyn and histamine connection and suggested his team might want to do a little more research on the new discoveries into narcolepsy.

 

Naturally, I didn't hear back from him and wasn't surpised.  He then tried to blame my company for chosing a policy which excludes, verbatim, "sleep disorders - TREATMENT, including sleep studies, for insomnia, sleep apnea, snoring, or any other sleep-related problem."  I've said this before,  narcolepsy has nothing to do with sleep.  Lack of sleep is just a symptom of a nuerological disorder but they want to make this illogical extension since I close my eyes at night, therefore, any problem that I feeling tired MUST be related to sleep.  If only my brain knew that sleeping should help me feel rested.

 

Luckily, I work for a multi-national company and they might have some influence on this desk jockey and his supervisors since they pay millions in premiums yearly.

 

I'm still baffled at how any medical professional could classify this as a sleep disorder.  No amount of sleep, meditation, rest, etc. ever takes away the feeling of tiredness.  It's like trying to sleep away diabetes or epilepsy or Parkinson's.

 

If it was that easy, I'd be sleeping 12 hours a day.

 

So frustrating educating people, especially doctors.



#8 Chemist

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Posted 21 December 2013 - 03:48 AM

Interesting, my health insurance policy also excludes sleep disorders, but I called in and just asked one question: "For the purposes of insurance benefits, how does your company categorize narcolepsy?" They placed me on hold for a few minutes while they spoke with their supervisor, came back and told me for the purposes of coverage it was categorized as a mental disorder and covered by the policy. I'm glad I had thought to call and ask because medication isn't cheap...

 

You're correct in your assertion that narcolepsy is not truly a disorder of sleep. Considering hypocretin/orexin is highly excitational in nature, it would be more appropriate to describe it as a disorder of wakefulness.



#9 supertired

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Posted 21 December 2013 - 11:49 PM

I requested a 2nd opinion from the insurance company and then they decided to extend me benefits.

 

I am so relieved.

 

thanks for everyone's advice and support.







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