In early October, I saw a dentist specializing in sleep apnea for a consultation on a mouthpiece to replace my severely under-utilized CPAP machine. I believe that most of my gasping for air and part of my inability to sleep is related to mouth problems; not nose problems. The dentist reaffirmed my diagnosis of a weak chin and jaw line which probably recedes when relaxed closing the airway. The CPAP machine doesn’t work for me and I believe the mouthpiece that moves the lower jaw forward could help. Problem is – insurance doesn’t get it.
The dentist is considered out of network although there are ZERO other dentists in the area (or in the entire state) that do this work. A pre-certification form was submitted to
After patiently waiting two weeks, I called the insurance company. I did the mandatory button pushing and asking for a representative for 12 minutes before finally getting connected to Byron. Byron said a non-participating request was under review. I asked him to explain to me the process of the review and a typical/average length for getting an answer. He said he couldn’t give a typical turnaround and that he had no further information for me. I asked him who would have further information. I got put on hold --- for 10 minutes.
How hard is it people to explain the process and help set the customer’s expectations? I guess it’s hard, but finally, after repeated requests to speak to a supervisor (no need, Mrs. Pitcher), Byron said the review is conducted by a nurse and/or medical director where they try to find in-network doctors. The review can take up to 14 days.
According to the dentist’s submission records, 14 days was last week, but according to the insurance company, 14 days ends today. So I am patient … until tomorrow. I’m guessing I’ll get a late answer of no, because I questioned the system. Purgatory is no fun.
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