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Red tape and high costs block sleep apnea patient's path to treatment

GONZALES - After being diagnosed with severe sleep apnea, Raymond Lanoux began exploring his options for care. In the past few months, he's learned that even though his treatment is approved, it's financially impossible to access.

Sleep apnea affects millions of adults. During sleep, people repeatedly stop and start breathing, preventing restorative sleep. If left unaddressed, frequent drops in oxygen can strain a person's overall health and put them at risk for other serious health conditions. 

Lanoux was prescribed a CPAP. Over several years of usage, he has complained about uncomfortable sleep.

"Waking me up throughout the night; I'm literally getting less sleep with the CPAP than with the sleep apnea," he said.

After trying a few masks and seeing his doctor, he was advised of two options. They include an oral appliance or surgery. His journey to accomplish either started in January. On the high end, an oral device costs about $5,600. Insurance will pay about 30%. A surgical implant is at least $60,000. While the surgery is in network, Lanoux's weight disqualifies him. Insurance won't cover a weight-loss drug because it has a weight-loss drug exclusion.

"Literally, you're telling me you can't give me the medication to lose the weight, I can't get the surgery because I weigh too much, and you're not going to pay for the dental appliance," said Lanoux.

Lanoux works as a software engineer and has appealed through his company's insurance, Premera Blue Cross Blue Shield Alaska.

Lanoux says the paperwork was looked over by an attorney, not a doctor. 

"They didn't even look at the case or why it would be needed," he said.

Lanoux even attempted to negotiate a single case agreement for the oral appliance. His insurance said it was denied.

"They came back and said they couldn't because Louisiana Blue Cross Blue Shield refused to sign a single case agreement with that dentist," he said.

It appears he has reached the end of his insurance road.

"It irks me that shouldn't be how insurance works; it should be there when you need it," said Lanoux.

After contacting 2 On Your Side, Lanoux heard from BCBS of Louisiana, which advised him to reach out to an oral surgeon. Lanoux said he did, but that surgeon does not make oral devices for sleep apnea.

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