Sleep Apnea Claim

[EODCMC]

Hi, I am a 30 year retired vet. I retired 13 years ago. I as recently diagnosed with "very severe" obstructive sleep apnea. The machine they gave me is preset on the highest output flow. My episode exceed 35 times an hour with some lasting more than 30 seconds. 

I was diagnosed with sleep apnea a couple of years prior to retirement and the study and diagnosis is documented in my record. In fact, they wanted to operate on my uvula. There lies the rub. The operation could have ended my career so I didn't persue. Additionally, while on active duty I developed severe chronic sinusitis and allergic rhinitis and this also is documented in my service health record. I have been living with this and chalking it down to getting old.

Fast forward...I recently got a machine that they say I have to wear for the remainder of my life. I just learned that Tricare Prime does not pay for it all. So, I researched online and submitted a claim the E-benefits and it has been received and was under review until today when they changed this to "gathering of evidence" Development Letter Sent.

Does anyone know what this means? What do I have to look forward to concerning the process. I watch the news. It doesn't look good, right?

thanks in advance.

[Andyman73]

Buck,

I was reading some of the past threads about Dr. Ellis, seems to be pretty squared away.  Not sure if his clinic does MH and SA work.  Maybe I just missed it on his website. 

I still have some $ left from my EED to cover the costs of the IMOs, but if I have to travel there....no way I'll be able to swing that with my boss(wife).

I will have to open that package from the NOVA lawyer, it has a copy of my C-file and some radiology images on discs. We'll see if there is a letter in there.  And if not, who do I contact in regards to reporting a NOVA lawyer for turning me away?

 

[Buck52]

Well look and see if they say why the turned you down? if good reason then that's up to you to report it!

 but if its not enough retro or some B.S. Like That I'd sure let the organization know about it and give out the name of  that''NOVA''  Attorney'  that turned you down or failed to help you in anyway with your claim.

I'm not sure if this is the correct address for complaints or not?

but it should get someones attention!

NOVA

1775 EYE STREET NW, STE 1150
WASHINGTON, DISTRICT OF COLUMBIA 20006
202.587.5708

[Andyman73]

I'll do that this evening after work.  Thanks for the address.

 

[wingnut73]

Alittle off topic, but still about sleep apnea.

I have been on a VA issued CPAP machine for 10 years in fact the 3rd machine.

The VA recently changed things issued from prosthetics. In the past when a mask became worn out about every 3 or 4 months I would call and they would send a new mask. That has changed ( not for the better) .

After 10 years I am told I must have a sleep study to get a new mask. Still not sure how this is going to work.

Anyone that has sleep apnea knows it. Do you wake suddenly with a snort?  That is caused by sleep apnea

[Buck52]

Well I have to request new mask or hose when they won't make a seal around my mouth or has a tear in the seal  , so I go to the sleep clinic and ask for a new mask or whatever I need for my VA Issue  C-Pap & So for no problems for me  they just send me to Prosthesis and I get it.

 I ask for two mask one full face and one just the nose pillow mask , I mention to the sleep Doc why...because of night sweats and nightmares I have...> the nose pillow mask stays son pretty good  vs the full face mask I knock it off usually.

I had a Private Sleep Study done with choice card last year Dec 2014  so for the sleep clinic as not required a sleep study when requesting Parts for C=Pap Machine...but I don't mind a sleep study if its at the same place I went to before , don't think I'd like a VA Sleep Study but I'd do one if they needed me too  I love my C-PAP.

[Gastone]

Wingnut, exactly who told you this? I just got New Mask, hose etc by sending a MHV Secure Message to the Sleep Dept Clinician that handles the Wed SA Walk-in Clinic.

This is (1) of those occasions where I would firmly request a Hard Copy of the "VA-VMC" Reg or Fst Letter addressing the need for an "Expensive & extreme;y time consuming New Sleep Study. Especially if your Cpap/Bipap equipment is damaged. I usually request an in-person discussion with the Dept Head. The very few times I've actually had to do this, the clinician has caved, claiming their going to make a special exception for me, Ya Right, but it worked.

Semper Fi