Dr. Ted’s Story

I have a patient, a 35 year old male with documented obstructive sleep apnea. I did a physical exam to confirm it and he has been observed by a family member who is a nurse that he stops breathing at night. I tried getting a full polysomniagram done but insurance denied it. They told me first I had to perform a home sleep test. We did that and I tried to order a polysomniagram again and was told we needed a Prior Auth. His insurance is through Anthem/BCBS. I called and gave them all of the information. They said “We have to transfer you to another company.” I gave the second company all of the information again to be told by the second company, “we do not provide services in your area.” At that point I had spent two hours of my time. I told them “You’re interfering with the care of the patient!” Finally I had to refer my patient to a pulmonologist. I thought a pulmonologist would have better luck getting through the prior auth process.