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Adventures in Sleep

Is Insurance in the Sleep Business?

Published May 2, 2013 12:12 PM by Amy Reavis

Care Centrix is the company that does the authorizations for sleep studies for Cigna insurance. They recently bought a home sleep company. They now not only get to make the decision on who gets a sleep study, they then order the study, send out either an HST machine or more often an autopap machine with instructions and basically tell the patient "best of luck."

When did insurance companies get in the business of practicing medicine?  Where is the care for the patient? Who is going to do the follow-up for these patients who may not have been diagnosed properly and who are definitely not being educated?

This is when we, as a field, need to make our voices heard. We are too quiet. We do not toot our own horns loudly enough. We need to prove that our time and education changes outcomes. We need to prove that it is not all about just obstructive sleep apnea but about the myriad of different disorders we help to discover. How many cardiac issues have we found? How many nocturnal asthma patients have we helped? Even the AASM thinks Cigna has gone too far. 

This is a call to action! Write the company and your representative. Write the insurance administration. We need to change this.

7 comments

My experience currently is a branch of Cigna whose patients are in a program called Sleep Management requires an HST, then a unit going home with a modem on it and Cigna monitors to decide if they will pay past the first month. Depending upon compliance. It is a mess.

D'Dee Morris, Respiratory Therapist - HST Coordinator, Sleep Medicine Assoc. of TX May 12, 2013 10:39 AM
Plano TX

FYI ...Care Centrix is also handling authorizations for BCBS of Florida.  We have had several patients contact our sleep center in the past month, with complaints as to how they are being treated by CareCentrix.  It's turning into a mess, and the sleep labs are taking all of the heat.  

MedSolutions is the company handling authorizations for Aetna, UHC and Cigna.   According to the rep I spoke with, MedSolutions has a total of 5 physicians serving on their "Sleep Medicine Review Board."  Only 2 of those physicians have a background in sleep or certifications from the AASM.

Dr. Gregg P Allen M.D. is at the head of this review board.  He is a radiologist with absolutely ZERO background in sleep medicine.

I have approximately 10 denial for study letters, signed by Dr. Allen sitting on my desk at the moment.  

In my opinion, if a pulmonologist with credentials from the AASM orders a sleep study, and that study is denied by a radiologist with no background in sleep medicine ..... there is a serious problem!

Jess OBrien, Polysomnography - RPSGT, SHC May 8, 2013 11:49 AM
Fort Myers FL

Get used to it.  Neither the Justice department or Commerce is interested in regulating vertically integrated monopolies anymore.

Sandy Ricket, Sleep - RRT RPSGT May 8, 2013 11:00 AM
Orlando FL

Maybe quality is not an intrest for them. I would prefer a company that requires a Sleep or Resp tech  to do the set up . If I had an insurance that sent me a Do it yourself kit with parts included I would drop them like a hot potato.  Maybe soon they will break new ground with a How to repair your own hernia in 5 easy to follow steps- parts once again included with a 1-800 nuimber incase you have questions or  missing a vital piece to complete the proceedure.

Don , resp/sleep - staff therapist, ILH May 8, 2013 5:13 AM
New Orleans LA

Insurance companies shouldn't be ordering any diagnostic tests but they have been making decisions about them for years.  Sleep tests are no different.

Rosemary Grefe May 7, 2013 10:50 AM

The only good that will come out of this situation is that the insurance company will save money and the patient suffer.

Jill Ortiz, Respiratory/Sleep - Director of Sleep Lab, MDMC May 7, 2013 10:07 AM
SIkeston MO

Interesting.  We are having trouble with Carecentrix exclusionary sleep program in our area.  We are told they only allow Watermark Medical as their preferred HST.  Then only allow setup by one of 13 contracted companies.  This has caused many complaints in our area.  What device did they buy?

ben griffin, sleep - president, home sleep services usa May 7, 2013 9:43 AM
Dalton GA

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    Adventures in Sleep
    Occupation: Sleep technicians
    Setting: Various sleep facilities
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