Inspire Sleep Apnea Device

MN-Jon

Well-Known Member
Registered Member
Does anyone have the VA criteria for getting authorized to have the Inspire Sleep Apnea device implanted? I am at 50% and had a sleep study done - got a score of 42.3.

I did a search on the site and only had one hit from 2016 - no one answered the questions then.

I have started the process to seek a consultation with an Ear Nose and Throat specialist - got a call back from the VA asking why I wanted to do this and questions about what the problems were with my CPAP - just wondering if there is any printed criteria as to who is allowed the procedure.

Thanks
 
Use tricare to get the inspire device if you can. Inspire is new and VA lags on new things.

I tried to get sleep apnea surgery through VA they simplest stated that I’m not a good candidate for surgery. Since then I’ve switched over to tricare, had a sleep study done AHI of 90! There is a great ENT doctor that I’ve now had 3 surgeries with, septioplasty to repair debates septum and 60% blockage, UPPP surgery and tonsillectomy. Now my AHI is 15 with a cpap, still have to get another study done without cpap to see how far that number went down to.

Inspire has thier own requirements, they denied me based on too high AHI (90), I think their max is 65. But you’ll need to get the pre authorization from tricare which means sleep study and referrals.
 
Called the VA to check on my referral request - apparently they denied my request - back on the 26th of September. I have not received anything from them confirming that.

I just had an appointment today with an ENT - using my BCBS and Tricare - the ENT told me she has had good luck getting the VA to cover the cost for others.

I'll update as I get more info...
 
Has anyone else had difficult times getting their doctors to take the time to write letters or support you with claims? One of mine simply said she will not write any letters. Naturally, she is the one I would need the most support from. She is my sleep doctor. In 2017, she refused to write a letter stating there were options for cpap use while deployed. As I left her office I stopped at the front desk and the person at the front desk told me they put together "deployment kits" complete with battery options. She would not even put that in a letter.
 
VAMC doctors are strongly discouraged from writing letters to support claims.

Try getting them to write in your records what you need to cope with your disability. This in turn can be used as evidence without them directly writing a letter.
 
The criteria for Inspire are:
1595546871609.png
 

Attachments

  • 1595546871690.png
    1595546871690.png
    23 KB · Views: 0
Top