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Criteria the VA uses to assign a 50% rating to VA Sleep Apnea Claims has just changed


Tbird

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That was my opinion on another forum and I was pilloried for it. Yes, the letter for necessity may be a pain, but its better than just having OSA and getting a CPAP and getting 50% BAM. Im sure there are doctors that will issue that stuff since insurance pays for it that don't document the rationale why they prescribed one- and even if they prescribed it that should take care of the letter requirements anyway. Not sure what the doom and gloom is to the first part of this change. I also see that Chris does not cite the relevant portion of the criteria, either. 

 

Edited by brokensoldier244th
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1 hour ago, brokensoldier244th said:

That was my opinion on another forum and I was pilloried for it. Yes, the letter for necessity may be a pain, but its better than just having OSA and getting a CPAP and getting 50% BAM. Im sure there are doctors that will issue that stuff since insurance pays for it that don't document the rationale why they prescribed one- and even if they prescribed it that should take care of the letter requirements anyway. Not sure what the doom and gloom is to the first part of this change. I also see that Chris does not cite the relevant portion of the criteria, either. 

This move does make some sense.

CPAP machines can be bought online dirt cheap for just a couple of hundred dollars. I can almost see a vet's spouse writing a statement that the vet must use the machine to sleep in fear of him dying. Add in a naive VARO rater and a vet can get a 50% rating ($836+/month) plus no co-pays for VAMC treatment, and a dependency claim.

I think the medical necessity should not be a problem for vets who really have SA. I know mine is medically prescribed. I got it from a non-VA medical supplier at a local hospital. When I picked mine up, I asked why all the paperwork. They said the devices are pricey and insurance companies are not going to cough up payment for something that is not deemed medically unnecessary, thus the prescription from a doctor after going through all the hoops (i.e. sleep study).

I would not be surprised if the VA requires the letter of medical necessity to be written on one of their "special" forms.

 

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I really expected them to 'split up' the SA Rating with this change and there has been talk of them actually reducing the percentage for several years starting in 2016.  I was expecting a 50% for prescribed w/compliance, 30% for prescribed but not used, etc, etc.

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 Great Information Ms Tbird  

I was diagnosed by VA for S.A. or from a private  sleep Apnea  Clinic the VA sent me to, & VA gave me a Cpap to use,

but here is the kicker  I never had any reports of S.A. in military, I am 70% sc for PTSD and it seems to me and my spouse my S.A. has worsen since taking the PTSD Medications..  I truly need the cpap because I stop breathing during the night without it.

I can't get a MH Doc to write me a letter stating that the medications I take for PTSD is a secondary condition that cause this veteran to have S.A. veteran is currently using a cpap machine at this time.

what is a veteran to do in this situation?

Thanks

............Buck

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