Insurance coverage for snoring surgery (painful, dentist, smoking, doctor)

[Chris_Davis]

I'm looking into surgery to cure my snoring. I've tried every remedy out there: breathe right strips, throat sprays, decongestants, the wedge pillow, sleeping on my side, etc. I had a sleep study done and I don't have sleep apnea.

I'd like to get the pilar procedure or some similar surgery done but my doctor said since I don't have sleep apnea it's a cosmetic surgery and insurance won't cover it. It's become a problem for both my wife and I and I'm constantly tired. I sleep on the couch occassionally but don't want that kind of marriage.

Any ideas on how I can convince my insurance company to cover it? The surgery runs about $2000 and as a NYC teacher can't afford it on my own.

[anderonia]

My husband snores. He found a web-site which provides white noise, and I have been happy ever since. His snoring was really annoying too -- very sporadic. The white noise sounds like the ocean.

[Chris_Davis]

Thanks! Do you know the website address?

[eddiek]

Without having sleep apnea diagnosed, I doubt that the insurance company will cover it. they may consider this, outside of the apnea diagnosis, as being a "cosmetic" procedure.

[paramour]

I worked for a large well-known insurance company for several years and agree with your doc. Unless you've been diagnosed with sleep apnea, then the insurance company will likely deny your claim, considering it not medically necessary. Other medical diagnoses may be considered for some surgical procedures, but "snoring" symptomology is typically insufficient rationale for them. Call your insurance company and ask them if they can tell you their requirements for coverage of whatever procedure you are seeking--Sometimes you might actually be able to get an answer out of them. ;p

[Burgi]

Originally Posted by Chris_Davis

I'm looking into surgery to cure my snoring. I've tried every remedy out there: breathe right strips, throat sprays, decongestants, the wedge pillow, sleeping on my side, etc. I had a sleep study done and I don't have sleep apnea.

I'd like to get the pilar procedure or some similar surgery done but my doctor said since I don't have sleep apnea it's a cosmetic surgery and insurance won't cover it. It's become a problem for both my wife and I and I'm constantly tired. I sleep on the couch occassionally but don't want that kind of marriage.

Any ideas on how I can convince my insurance company to cover it? The surgery runs about $2000 and as a NYC teacher can't afford it on my own.

Did the sleep study show anything? The surgery you are speaking of is extremely painful and not all that sucessful. My dh has severe sleep apnea and his physician said it has a 50% failure rate at 5 years. Very invasive procedure to have with those odds (even if insurance pays).
Smoking and obesity can lead to snoring. You can also have a mouth splint custom made at your dentist office, or buy one a ready made one at the drug store(not supposed to work as well). Good luck!

[LaceyEx]

Burgi-re surgery for sleep apnea-our son had the surgery in late Mar. '07. It was extensive and painful for about 2 weeks but well worth it. His involved removing his tonsils (which doctor said were HUGE), reducing size of palate and tongue and removing uvula. His symptons went away immediately-he's a new person.

[Burgi]

Originally Posted by LaceyEx

Burgi-re surgery for sleep apnea-our son had the surgery in late Mar. '07. It was extensive and painful for about 2 weeks but well worth it. His involved removing his tonsils (which doctor said were HUGE), reducing size of palate and tongue and removing uvula. His symptons went away immediately-he's a new person.

Yes, I have heard it works at first. My husbands sleep doctor told him she strongly recommends patients do not have that surgery. She said the studies have shown that 50% of patients are snoring the same or worse than before surgery after 5 years. We have 4 friends/relatives who have had that surgery, 2 had no symptoms for a year, 1 had no symptoms for 2 years, 1 had no benefit at all. I think it is an extremely painful and invasive surgery for those odds.

[bibit612]

Might you have a deviated septum? That might cause snoring according to this article, without necessarily having sleep apnea. You might be covered then. I would seek a second opinion.

Deviated septum - Wikipedia, the free encyclopedia