I use United HealthCare for my health insurance needs. Like the majority of self-employed people in the US, I bought through the Marketplace. Not a big deal, in and of itself – except for all the ranting and finger pointing people give to people who use Marketplace to get insurance, but once you get past the Marketplace, things sort of fall apart.
In February, my neurologist ordered a sleep study. I snore like a grizzly bear with a cold, have chronic migraines, and usually need a nap in the afternoons. I was denied an in-clinic sleep study, but approved for an at home study. The study did find that I had breathing problems when I sleep.
My neurologist then ordered a full, in-clinic sleep study. Which United HealthCare once again denied, but approved a CPAP machine.
Last week, I got a call from the home health company telling me that my CPAP was ready to be picked up. Insurance had approved it. I just needed to go down, get it pressurized, and pick it up. And I did, on Monday. I even paid my copay.
Tuesday, I received a letter telling me that United HealthCare had no evidence that I had a breathing problem at night and therefore, my claim for the CPAP was denied. It was dated June 3, 2016… 10 days before I picked up the machine and almost a week after I talked to the health equipment provider that said it had been approved.
The letter informed me that they had no record of a sleep study, which was required for a diagnosis. It also said that there were no notes in my chart that showed I had symptoms of a breathing problem which included; tiredness, snoring, stopping breathing, headaches, etc.
I called, they couldn’t find anything and said they’d call me back. I’m still waiting…