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Pre-existing Tinnitus, Hyperacusis, and Meeting CPAP Insurance Compliance Guidelines


#1

Hello there. I just received a CPAP machine and mask about two weeks ago. I have pre-existing hyperacusis that I was diagnosed with at least a year and a half before I even began using CPAP, and pre-existing tinnitus that I had, to a certain degree, at least several months to a year before using CPAP for recently-diagnosed sleep apnea. I do realize that, in order for insurance to pay for all of the CPAP equipment and NOT instantly take it away from you, I must comply to wearing the mask, etc. for at least 21 days during a month (I am not sure if it is at least 21 days for the first month, or at least 21 days for three months in a row; I need some clarity regarding this).

Anyway, both my hyperacusis and tinnitus were not acting up much at all for some time before I introduced the CPAP device into my life. Ever since I’ve been using the mask/machine, I have experienced all types and excacerbations of ear problems: deep pain in my ears (which seems to go deeper and deeper, and last longer and longer the more days and nights that I use CPAP); intense pressure and fullness in my ears (also, which gets worse the longer I use CPAP); pressure in my head (in addition to the migraines I already get on a daily and nightly basis); and fast, heartbeat sounds in my right ear (which have gotten worse the longer I use CPAP). Also, I have had two gum surgeries in the past – and have most recently begun to experience dental, gum and jaw pain (and that was AFTER I introduced the CPAP machine and mask into my life); I was not experiencing any type of mouth pain before introducing the CPAP machine/mask.

As far as the ear problems go, I feel it is basically “hell” on my ears having to listen to the constant (daily and nightly), foghorn-like droning sound which emits from the CPAP machine itself; this, in addition to the air that (of course) constantly whooshes out of the exhalation ports (etc.), is getting me terribly upset and causing me to feel as if I am in a “catch 22” situation. I feel that I am under pressure by the insurance company to meet each and every compliance deadline, “come hell or high water” – no matter how worse my ears/hearing actually gets (and perhaps no matter how many dental problems I may be experiencing as a result of it). My husband works with an ENT doctor, with whom he consulted about my ear issues; he suggested I get custom-made earplugs – even though the “good” earplugs I have been wearing do NOT solve my problem – and may even be making my problem worse. Also, the ENT who originally diagnosed me with hyperacusis is now on vacation. I do have the following questions that I desperately need answered: 1. Will I be able to wait until she comes back from vacation, and will I be able to “wait in the wings” to actually be seen by her or one of her colleagues BEFORE the strict amount of days the insurance company gives me to wear the mask actually run out? 2. If I do wind up getting custom earplugs, will they be ready for me to meet the insurance deadline(s); and 3. Do I have an advocate anywhere in this process (or perhaps my questions should really be: exactly who would be my BEST advocate)? After all, the insurance company will not let me see my actual sleep doctor/pulmonologist until almost a month from now.

I will call my DME company to ask them for their advice. Also, I will make an appt. to see an ENT – so that he/she can perhaps help me to a certain degree – even if that means their writing me (or my eventual sleep doctor) a note to explain the predicament I am now in (and if it is possible for the insurance company to grant me at least a little more time).

The company “Phillips Restoronics” also said, in their literature, to stop using the device and call a doctor if a person experiences any dental, gum or related pain – however, will the insurance company “buy” this (or will they simply look at me as a person who has “failed to meet the dates/deadlines”)?

Can anyone perhaps offer me any added suggestions or support regarding my dilemma? I would greatly appreciate any and all suggestions. Thank you so much.


#2

So sorry to see you struggle. To clarify, Insurance generally requires a minimum of 4 hrs use a night. How many hours are you wearing each night? It also can be seen as needing 21 out of 30 days use but the 4 hours/day may be less invasive and easier to achieve.
Unfortunately Insurance usually only “sees the black & white”, they look for compliance or intolerance period.
Are you using CPAP or BIPAP? If you are on a CPAP you may be able to classify as unable to tolerate CPAP pressure & be retitrated to a BIPAP machine. A BIPAP might make it easier to adapt to therapy having 2 different pressures.
You should definitely communicate with your care team about your dental pain, that needs to be investigated further also.
I hope this offers at least a bit of help…


#3

A couple of things strike me as curious.

Did you sleep specialist know about these preexisting conditions at the time of your sleep study? They should have access to EMR and be aware of the potential challenges with using CPAP in your case. Did you have discussions about this before trialing your CPAP?

Also, insurance should also know of these issues so that they can exempt certain compliance requirements. You can be an exception to the rule but it will require that you serve as your own advocate and talk to many people at your payer’s office to ensure they are on the same page.

Definitely you need to call your sleep specialist, have them communicate with your ENT, and also phone your insurance company to explain the situation. Your sleep specialist should be able to file requests or other paperwork as a way to waiver certain compliance demands. But even more so, they may wish to rethink CPAP for you, given these problems, and explore other options.