I mentioned the results of my sleep study in Friday’s post. Sleep specialists use the apnea-hypopnea index (AHI), a scale that tells whether you have sleep apnea and how serious it is. When I was given the results by the doctor who read the sleep study, she gave me the score based on the criteria set by the American Academy of Sleep Medicine (AASM).
Late Friday afternoon, my sleep medicine provider called me to discuss my results. She explained to me that there are actually two scales used. The one the doctor had sent me a message about was the one determined by the AASM, which is accepted by most insurance companies, and according to that scale, I am above the limit for the Inspire therapy implant. However, there is a second scale used by the U.S. Centers for Medicare & Medicaid Services (CMS). This is the scale used by Medicare and Medicaid to determine AHI.
I know all of this may sound technical, God knows it does for me. But the important thing my sleep medicine provider told me was that according to the AHI scale used by CMS, I qualify for the Inspire therapy implant. In other words, if I had Medicare or Medicaid, I’d qualify, but most other insurances don’t recognize the CMS AHI as a valid criteria.
Now, just because my insurance Cigna doesn’t normally recognize the CMS AHI score doesn’t mean they can’t be convinced otherwise. So, because I meet all of the other criteria, especially intolerance for the CPAP, she is referring me to the ENT specialist that does consultations for the Inspire therapy at Dartmouth-Hitchcock Hospital. She believes there may still be some hope.
The ENT would still have to do an endoscopy to see if my throat is round enough to meet the last criteria. I will have to consult with the ENT though before she will agree to go forward with qualifications for the procedure and getting it approved by Cigna. I suspect, I will not be able to see the ENT until the new year, but I’m hoping to hear from her office at some point this week.
Quick Update: The ENT doctor’s office called and I have a consultation on Jan. 10.