Insurance Company Hall of Shame – United Health Care
Recognizing that a private health insurance companies primary purpose is to make profits for itself, most insurance companies still try to do right by their members. There should be an Insurance Company Hall of Shame for those insurance companies that do not.
Many private insurance companies now require Home Sleep Apnea Testing for sleep apnea rather than in-lab Polysomnography. Almost all have several exceptions, which allow in-lab Polysomnography rather than Home Sleep Apnea Testing. Although these exceptions are not sufficient, and research suggests there should be more exceptions, most insurance companies do follow their own rules. United Health Care, on the other hand, allows very few exceptions.
I had a patient with cataplexy and sleepiness. Patients with cataplexy and sleepiness almost always have narcolepsy. She had no other reason to believe she had sleep apnea. United Health Care made her get a Home Sleep Apnea Test. When that was inconclusive, United Health Care insisted on a Polysomnography. When that was negative for sleep apnea, United Health Care finally allowed Polysomnography with Multiple Sleep Latency Testing for narcolepsy.
United Health Care Community Plan rejected a request for Polysomnography, insisting on Home Sleep Apnea Testing. When we performed that, United Health Care Community Plan refused to pay stating Home Sleep Apnea Testing was not covered. This is quite a Catch-22!
When it comes to treatment of sleep apnea, United Health Care insists on APAP. It will not allow a CPAP titration polysomnography. If a patient cannot tolerate or does not respond to APAP, most private insurance companies allow a CPAP titration polysomnography. I had a patient who could not tolerate the APAP (as the pressures often get too high on APAP). United Health Care refused to allow a CPAP titration. I requested an appeal with a physician. The physician told me to put the patient on decongestants!
Therefore, United Health Care richly deserves nomination into the Insurance Company Hall of Shame.