FAA adds another hoop for medicals

[Henning]

For those of you demanding the irrefutable data, I have one question for you, "How do you suggest it be gathered?" Mind you, there is more than falling asleep, narcolepsy, that is an issue here; there is also general cognitive impairment. How does one associate which accidents that result in the question, "What were they thinking?" with what cause once the toxicology results come back negative?

OSA has been shown to cause cognitive impairment equated to being drunk beyond legal standards. I have seen people in this thread complaining who would also be brutal on a person in a DUI thread who has no remorse.

The fact is, the level of evidence you ask for is unavailable until after the OSA situation has been addressed and a statistical comparison and analysis of before and after are made.

 

[weilke]

Once I went on CPAP I lost over 70 pounds, my BMI is now about 28, I'm off of all medications, and I feel much better in all respects.

That sounds horrible, why would anyone want THAT ?

 

[bbchien]

For those of you demanding the irrefutable data, I have one question for you, "How do you suggest it be gathered?" Mind you, there is more than falling asleep, narcolepsy, that is an issue here; there is also general cognitive impairment. How does one associate which accidents that result in the question, "What were they thinking?" with what cause once the toxicology results come back negative?

OSA has been shown to cause cognitive impairment equated to being drunk beyond legal standards. I have seen people in this thread complaining who would also be brutal on a person in a DUI thread who has no remorse.

The fact is, the level of evidence you ask for is unavailable until after the OSA situation has been addressed and a statistical comparison and analysis of before and after are made.

Jim in Texas:
THIS!

But until NWA (MSP we were playing with our computers...lairs") and the ATC debacle at Reagan National, the agency could resist doing this. But no longer.

 

[Capt. Geoffrey Thorpe]

From the attachment that Dr. Chien posted:

"Once we have appropriately dealt with every airman examinee
who has a BMI of 40 or greater, we will gradually expand the
testing pool by going to lower BMI measurements until we
have identified and assured treatment for every airman with
OSA."

So youse guys are wasting your time arguing about BMI since all y'all are going to get screened eventually.

 

[Unregistered]

Honest question. So did the NWA guys finally admit they fell asleep or are they saying that sleep apnea caused them to have poor judgment and play on their laptop/argue about their schedules? Seems kind of fishy to me either way. Crazy part is I heard the FO got his job back eventually and maybe even the Captain. The NTSB report never mentioned this sleep apnea if I remember correctly. It seems to me like we are one incident like that away from going to astronaut style physicals that will cause an even larger pilot shortage.

 

[Fearless Tower]

Honest question. So did the NWA guys finally admit they fell asleep

AFAIK, they held on to their laptop story.....just like the TWA guys who rolled the 727 never admitted to screwing around with the configuration in cruise.

 

[weilke]

So youse guys are wasting your time arguing about BMI since all y'all are going to get screened eventually.

Mark my words, 3 years from now we will ALL get screened with the following questionaire. That will be with and without the rulemaking process being involved:


Do you snore loudly (louder than talking or loud enough to be heard through closed doors)? Y/N

Do you often feel tired, fatigued, or sleepy during the daytime? Y/N

Has anyone observed you stop breathing during your sleep? Y/N

Do you have or are you being treated for high blood pressure ? Y/N

Is your BMI more than 35kg/m2 ? Y/N

Are you older than 50 years of age ? Y/N

Is your neck circumference greater than 16 inches (or 40cm) ? Y/N

Are you male ? Y/N


The standard scoring for this questionaire puts you at a moderate OSA risk with 3 positive answers. As Tilton doesn't believe airmen on all the self-reported items, he has apparently reduced the number or required positives to 2.

 

[Palmpilot]

For those of you demanding the irrefutable data, I have one question for you, "How do you suggest it be gathered?" Mind you, there is more than falling asleep, narcolepsy, that is an issue here; there is also general cognitive impairment. How does one associate which accidents that result in the question, "What were they thinking?" with what cause once the toxicology results come back negative?

OSA has been shown to cause cognitive impairment equated to being drunk beyond legal standards. I have seen people in this thread complaining who would also be brutal on a person in a DUI thread who has no remorse.

The fact is, the level of evidence you ask for is unavailable until after the OSA situation has been addressed and a statistical comparison and analysis of before and after are made.

I don't know about "irrefutable," but the DOT Web site summarizes a study that managed to find a way to gather data about truckers:

http://www.fmcsa.dot.gov/facts-research/briefs/SleepApneaCrash-RiskStudy-TechBrief.htm

 

[Henning]

Jim in Texas:
THIS!

But until NWA (MSP we were playing with our computers...lairs") and the ATC debacle at Reagan National, the agency could resist doing this. But no longer.

Oh, so we have a test case then?

 

[Doggtyred]

90% of accidents are pilot error.
SA untreated has been shown to be the equivalent of 0.08 alcohol.
Now read 67.113, 67.213, and 67.313 and tell me he doesn't have the authority.....

Enough, Nate. Enough.

Guys…. I'm in the BMI 40 crowd. Yea.. I'm a fatty. Yea. I'm working on it…

I had untreated sleep apnea for a LONG time.. years.. and I did work arounds until nothing else worked. Sleeping on my stomach with my cheek on the edge of a folded pillow, so that when I relaxed my jaw hung forward instead of back, avoiding obstruction. That worked for quite a while.. many years.. but i reached the point of diminishing returns, then things kinda snowballed. weight shot up, none of my positioning worked...

The first "in your face" warning sign was when the cardiac monitor rep came to visit us in the ICU and I was a guinea pig and hooked myself up to the pulse ox… one of my peers didn't like what he saw in pulse ox variation… (not to mention I was already tired all the time)…


Later that year, the narcolepsy hit. Middle of broad daylight at high noon driving down the freeway and the overwhelming urge to go to sleep strikes out of nowhere and you are nodding off. That scared the shoe polish out of me, and when I self referred for my sleep study I was promptly diagnosed with severe sleep apnea, one of the worst the tech had seen. Fortunately, despite my stubborn history, I had avoided right heart failure, and now I'm 100% compliant with my blower.

I functioned on **** poor sleep for YEARS. Got my ticket, flew cross country at 10-12000 feet, all with undiagnosed OSA (I wasn't BMI 40 then, but still heavy)…

This FAA initiative addresses a real and valid concern…and they set the bar VERY high. I never saw the narcolepsy coming. and it took everything I had to NOT nod off at freeway speed. I would have been hard pressed if I was shooting an approach to minimums or something else challenging.

Thing is… if you are able to document compliance on a sleep study, and have no symptoms of right heart failure, its a fairly straight forward issuance, as doc Bruce has mentioned before. The FAA set the bar pretty far out there, and it addresses a real problem.

 

[bbchien]

THAT, was Brave, Dave. Thanks.

 

[denverpilot]

NWA overflying MSP because the pilot has SA (and we KNOW that now)? Yes.

There! A real data point! I'd never seen that info.

Nate, if it came to it, I'd probably have to decline you as a patient (liability reasons!). Say I did back surgery and got rid of that sciatic pain, but told you no driving for six weeks. You'd be out there in a week driving around..... (cringes)
"well, I felt fine and didn't see a problem...."

LOL. I'm a skeptic Doc, I "ain't stupid". I even took all six antibiotic pills in my Z-Pack this year. Heh. I do follow instructions even if I whine loudly about them.

Thanks for laying it out. I get it now. I said I would accept one data point and I meant it. One. You came through.

(Damn skeptical engineer mindset, eh?)

 

[Henning]

Can you preempt and circumvent by just voluntarily going on CPAP? How about writing an exemption for people who can show machine compliance with good result with a positive interview. Can anyone see a reason that shouldn't be accepted by someone?

 

[denverpilot]

Do you snore loudly (louder than talking or loud enough to be heard through closed doors)? Y/N

Occasionally as far as I know. My wife, frequently. (And I've been keeping her updated on this thread actually.)

Do you often feel tired, fatigued, or sleepy during the daytime? Y/N

Yes, but usually after overnight work mandated by my job. I also spend a day or two getting sleep rhythm back to "normal" times after an overnight work requirement larger than a 20 minute on-call call and resulting troubleshooting.

Karen: She says no but I'm not sure. I'll add that I sometimes can't get to sleep because of the lovely beautiful gorgeous freight train I share a bed with. Heh heh.

Has anyone observed you stop breathing during your sleep? Y/N

Karen says no. I am convinced I've seen HER do it, however.

Do you have or are you being treated for high blood pressure ? Y/N

Me, no. Karen, yes.

Is your BMI more than 35kg/m2 ? Y/N

Neither of us. I think. Freaking kilograms. LOL.

Are you older than 50 years of age ? Y/N

No.

Is your neck circumference greater than 16 inches (or 40cm) ? Y/N

Me, yes. Since before i had any additional weight at all.
Karen, no.

Are you male ? Y/N

Me, yes. Karen, no. LOL (I'll double check.)

The standard scoring for this questionaire puts you at a moderate OSA risk with 3 positive answers. As Tilton doesn't believe airmen on all the self-reported items, he has apparently reduced the number or required positives to 2.

I figured I'd answer since Doc said I wasn't interested in being a better airman. (poke poke, Doc)

So... What would you say? Get Thee to a Nunnery? (Er, sleep study center?)

I think Karen needs to for certain. I'm slowly working on her. She takes exception to listening to recordings of her snoring. Heh. Go figure.

What'cha think Internet Doctors? (And the few real ones here.)

 

[denverpilot]

THAT, was Brave, Dave. Thanks.

Agreed. Thanks Dave.

That sudden onset of narcolepsy would be downright terrifying. Holy schnikeys!

 

[Too Lazy to Login]

What'cha think Internet Doctors? (And the few real ones here.)

Why not just take the lead and get one done for youself. Seems you have a couple of the risk factors yourself and taking the lead might encourage a resistant wife to do the same. Down side you end up with an easy to handle SI. However the upside from what I gather from reading this thread is better health and longer, quality of life for the both of you (should either of you suffer from OSA of course).

And if you're both in the clear...then you'll sleep better at night knowing.

 

[denverpilot]

Why not just take the lead and get one done for youself. Seems you have a couple of the risk factors yourself and taking the lead might encourage a resistant wife to do the same. Down side you end up with an easy to handle SI. However the upside from what I gather from reading this thread is better health and longer, quality of life for the both of you (should either of you suffer from OSA of course).

And if you're both in the clear...then you'll sleep better at night knowing.

True. We chatted tonight and Karen's a nurse. After being shown the questionnaire she isn't stupid either. Heh... She said she's going to talk to her Doc and go if the Doc agrees.

We'll probably also peek at what's covered under our insurance and push it into 2014 to hit the new monies in the Flexible Spending account. If I can figure it out before open enrollment closes, I might bump the contribution to the account prior to the closing of the open enrollment. Might as well be healthy and tax free, eh? Haha.

For me, I might have to wait a while just for simple logistics. My co-worker and only other Denver-based Linux admin quit, so I'm officially on-call 24/7 until we hire a FNG. I'm guessing getting called at 3AM in the sleep study place tends to waste everyone's time.


Sent from my iPad using Tapatalk

 

[Dav8or]

From the attachment that Dr. Chien posted:

"Once we have appropriately dealt with every airman examinee
who has a BMI of 40 or greater, we will gradually expand the
testing pool by going to lower BMI measurements until we
have identified and assured treatment for every airman with
OSA."

So youse guys are wasting your time arguing about BMI since all y'all are going to get screened eventually.

I think sales of LSAs might be seeing a bump soon. This in my mind is the proverbial "hand writing on the wall". What other grounds for disqualification can the medical community come up with? Loads I'm sure. Dr. Bruce says not to worry about expansion, but in this age of boosting the economy by government spending, how hard is it to just hire more bureaucrats to deal with the work load in the interest of safety?

 

[Matthew]

Can you preempt and circumvent by just voluntarily going on CPAP? How about writing an exemption for people who can show machine compliance with good result with a positive interview. Can anyone see a reason that shouldn't be accepted by someone?

If you do get the sleep study and CPAP, then you have an OSA diagnosis and need the SI.

If you are asking about just getting onto CPAP on your own and showing a compliance report - the catch with that is CPAPs are supposed to require a prescription, and I don't know how many docs will write that script without a diagnosis.

 

[Henning]

If you do get the sleep study and CPAP, then you have an OSA diagnosis and need the SI.

If you are asking about just getting onto CPAP on your own and showing a compliance report - the catch with that is CPAPs are supposed to require a prescription, and I don't know how many docs will write that script without a diagnosis.

Order it on the Internet, same as pharmaceuticals.

 

[Matthew]

Order it on the Internet, same as pharmaceuticals.

I do.

Most online places are pretty lax: "We need to see a precription. So go ahead and fax or email it in. In the meantime, we'll ship your CPAP."

 

[flyingcheesehead]

The most amazing thing about this, is the well treated SI, is ROUTINELY given on the phone. It's EASY!!

This tells me that airmen (YOU included) don't care about becoming better airmen.

Easy there, Bruce. That finger you're pointing is *almost* aimed at me.

My concern comes from the fact that A) right now, a sleep study is really expensive and probably out of pocket, [noparse]B)[/noparse] a friend of mine who did it voluntarily has gotten to the point where he's quit flying because it's such a pain in the ass for him to get his medical (I should probably send him to you), and C) if the FAA has no qualms whatsoever about imposing expensive diagnostics on pilots and gets away with it freely, where will we be in 10 years?

If there was *no* possibility that either an outright denial, or having to deal with an annoying/difficult/probably expensive test every couple of years was in the future, I bet a lot more airmen would "care about becoming better airmen." Forget the statistics - And I'm not subject to this particular policy, YET - This feels kinda like a witch hunt. It's certainly divide and conquer.

Make it something the AME can deal with (even if that requires some extra training for them), make it something that's reasonably priced and easy to do, make it so there's a way to get a medical no matter what, and nobody would be complaining.

NWA overflying MSP because the pilot has SA (and we KNOW that now)? Yes.

Wait, what? We do? Since when? And is it really that, or was that yet another convenient excuse cooked up by their lawyers so they could be "treated" for it and get their jobs back?

 

[Gary F]

My concern comes from the fact that A) right now, a sleep study is really expensive and probably out of pocket,

True, but so are nuclear stress tests for those with coronary artery disease. Many things in medicine are over priced due to a variety of factors

C) if the FAA has no qualms whatsoever about imposing expensive diagnostics on pilots and gets away with it freely, where will we be in 10 years?

In case you missed my previous post, morbid obesity (BMI over 40) is considered a disease in itself (ICD code 278.01) and once you meet the criteria for the diagnosis the FAA medical department gets to decide what hoops you must jump through to get certified. Unlike many other medical issues, the airman has complete control over having or not having this disease. Two years ago I had a BMI of 36, today 27. I will consume under 1,000 calories today, well under the average for most people on Thanksgiving. Weight loss is not easy but it can be done.

 

[bbchien]

I think sales of LSAs might be seeing a bump soon. This in my mind is the proverbial "hand writing on the wall". What other grounds for disqualification can the medical community come up with? Loads I'm sure. Dr. Bruce says not to worry about expansion, but in this age of boosting the economy by government spending, how hard is it to just hire more bureaucrats to deal with the work load in the interest of safety?

The KEY is to not allowing federal spending to increase. That's the problem with congressionally mandated Rulemaking. DOT wil be able to say, "well, you mandated this, so we need more staff".

The "reasonableness" of FAA, IRS, HCFA, is controlled by EXPENDITURE. That is why I shuddered with the ACA of 2010.

 

[bbchien]

Easy there, Bruce. That finger you're pointing is *almost* aimed at me.

My concern comes from the fact that A) right now, a sleep study is really expensive and probably out of pocket, [noparse]B)[/noparse] a friend of mine who did it voluntarily has gotten to the point where he's quit flying because it's such a pain in the ass for him to get his medical (I should probably send him to you), and C) if the FAA has no qualms whatsoever about imposing expensive diagnostics on pilots and gets away with it freely, where will we be in 10 years?

If there was *no* possibility that either an outright denial, or having to deal with an annoying/difficult/probably expensive test every couple of years was in the future, I bet a lot more airmen would "care about becoming better airmen." Forget the statistics - And I'm not subject to this particular policy, YET - This feels kinda like a witch hunt. It's certainly divide and conquer.

Make it something the AME can deal with (even if that requires some extra training for them), make it something that's reasonably priced and easy to do, make it so there's a way to get a medical no matter what, and nobody would be complaining.



Wait, what? We do? Since when? And is it really that, or was that yet another convenient excuse cooked up by their lawyers so they could be "treated" for it and get their jobs back?

In the investigation that followed, the PIC was noted to have a BSA of over 40, the FO was near same.

Despite their cockamamie story about "working the scheduling computers" FAA concluded (they're BOTH apparently now on CPAP, and that is known to FAA), that they intentionally allowed the CVR to continue (if they had pulled the breaker it would have exonerated them but the CHOSE not to do so), and every long transport captain (I have had that experience, too) concluded that they had fallen asleep.

Tilton and Babbitt both had long routes during their careers. And the first question an Orion crew asks, is, "who's got the bunk?".

How can one, awake, not hear the ACARS chime. it's LOUD.
So they had fallen asleep at the switch, and they are both now known to have sleep apnea.

Deny, Deny, Deny!
Read it and weep, Kent.

 

[flyingcheesehead]

In the investigation that followed, the PIC was noted to have a BSA of over 40, the FO was near same.

Despite their cockamamie story about "working the scheduling computers" FAA concluded (they're BOTH apparently now on CPAP, and that is known to FAA), that they intentionally allowed the CVR to continue (if they had pulled the breaker it would have exonerated them but the CHOSE not to do so), and every long transport captain (I have had that experience, too) concluded that they had fallen asleep.

But is it your theory, or was that an official conclusion or an admission?

Read it and weep, Kent.

I ain't weepin', I'm bitchin'.

 

[bbchien]

Official Conclusion via direct visit over lunch in Tampa. However, to requalify, these two guys got their SA dealt with.....and they did, and their private physicians had to have concluded, that SA was present.

Just because one don't think one fits in the statistics.....remember that stats include everybody. Deny, deny, deny. The FAA will have none of that any longer.

 

[flyingcheesehead]

True, but so are nuclear stress tests for those with coronary artery disease. Many things in medicine are over priced due to a variety of factors

Gary, if they expand this to the point that they want to, the majority of medical applicants are going to be required to spend a couple grand to get a medical. Congratulations, you just increased the price of a private pilot certificate by 50% and killed the industry! But it's OK, because it's expensive to get a medical after a heart attack?

In case you missed my previous post, morbid obesity (BMI over 40) is considered a disease in itself (ICD code 278.01)

ICD9 or ICD10? I get the feeling that ICD10 has a code for boogers.

and once you meet the criteria for the diagnosis the FAA medical department gets to decide what hoops you must jump through to get certified. Unlike many other medical issues, the airman has complete control over having or not having this disease.

To a point. IMO, the BMI is biased against tall people (of which I am one) - for me to be a "normal" weight according to BMI, I would actually have to be so thin as to be almost unhealthy. I'd love to be at the high end of "overweight". The BMI, in using height squared, conveniently ignores the fact that we are indeed three-dimensional creatures. Weight over height *cubed* with the appropriate conversion factor, I wouldn't have as much of a complaint with.

For reference, I developed that conversion factor based on an average-sized (5'7", 140lb) person for the heck of it, 'cuz I wanted to see what my BMI would be on a scale that's not skewed improperly for height. The answer? 32.3. My BMI based on the current scale is 36.5. I don't look at all like the "severely obese" silhouette posted before.

I guess I'm just not OK with requiring large numbers of potential airmen to go through tests costing four figures when they don't show actual symptoms of the disease, based on what IMO is a somewhat flawed measure.

Require it of everyone in a format with a reasonable cost (I'd be happy to sleep in my own home with a video camera and recording pulse ox for you with a $100 fee to review the data afterwards) - Or require it based on actual symptoms - Or don't require it at all.

Two years ago I had a BMI of 36, today 27. I will consume under 1,000 calories today, well under the average for most people on Thanksgiving. Weight loss is not easy but it can be done.

Is too easy. I lost 10 pounds the other day. All I had to do was get food poisoning.

 

[flyingcheesehead]

Just because one don't think one fits in the statistics.....remember that stats include everybody. Deny, deny, deny. The FAA will have none of that any longer.

Bruce,

I understand there's a high correlation. But why are we looking at that, and not actual symptoms? What about those 30% with a normal BMI? Are we really going to sit back and allow aeromedical to kill the industry by requiring expensive tests of people who show no symptoms?

Data is my job, I would *love* to get my hands on the height/weight/apnea data (anyone know a source?) and come up with a measure that works even better. And the height factor will be cubed, as it should be. Right now, we're essentially measuring a ratio of our weight to our surface area, not our volume.

 

[azure]

And the height factor will be cubed, as it should be. Right now, we're essentially measuring a ratio of our weight to our surface area, not our volume.

Ooooh. Kent, weight to volume would be essentially density. There's a reason that people with a high body fat content have greater buoyancy in water.

Maybe try 2.5 instead of 3...

 

[weilke]

ICD9 or ICD10? I get the feeling that ICD10 has a code for boogers.

Well, it does have a code for 'being hit by a spacecraft' with subdivision into being hit while being on earth and in orbit.

278.01 is a ICD9-CM code. Then again, 'running away from your master' and homosexuality were considered diseases at one point or another.

 

[bbchien]

Bruce,

I understand there's a high correlation. But why are we looking at that, and not actual symptoms? What about those 30% with a normal BMI? Are we really going to sit back and allow aeromedical to kill the industry by requiring expensive tests of people who show no symptoms?

Have you read all the posts in this string- from NealKas, and from myself about our local orthopedist narcoleptic surgeon.....and there are several others. The problem is the data you want to demand cannot possibly exist- how do you prove an accident was due to narcolepsy. Demand in cockpit image recorders on steel tape? Demanding that sort of data would require 80-100 pounds of CDR equipment even on a C150.....

Data is my job, I would *love* to get my hands on the height/weight/apnea data (anyone know a source?) and come up with a measure that works even better. And the height factor will be cubed, as it should be. Right now, we're essentially measuring a ratio of our weight to our surface area, not our volume.

That correlation (SA vs BMI, is very very good and is very vetted. Do a Medline search. That work I will not do for you.

The data are published in this string. 90% of the population with BMI>=40 have Sleep Apnea. 90% of aviation accidents are pilot error.

Now we have two index events.

deny, deny deny.

Stick your head in some more sand.

 

[denverpilot]

Heh. Getting interesting around here.

Tossing this out... For those who've done a sleep study, does "typical" insurance cover any of it?

This is related to tax planning. Karen wants to chat with her Primary Care Doc about it but if we end up doing anything in 2014, I'd have to adjust the Flexible Spending Account upward during our open enrollment period, which ends Monday.

At the end of the day if her Doc (or mine) says "do it" we will, but it'd be nice to stiff Uncle Sam for the taxes normally paid on the money paid. (Which helps that lack of funding that Doc claims will be the limitation on implementation, too! I figure the medical device lobby will make sure the thing is fully funded even at the expense of something else once they smell money.)

 

[weilke]

Tossing this out... For those who've done a sleep study, does "typical" insurance cover any of it?

Look up the insurers coverage policy and see what they require. Make sure the doc documents whatever is required in the order for the exam.

Your price for the study is whatever the insurance has contracted with the center. As a high-deductible customer, you want to shop around, contracted rates do vary.

A portable study tends to be a lot cheaper. Some insurers only pay for the in-house study under a limited set of circumstances.

 

[Gary F]

Expensive outpatient diagnostic tests like cardiac stress tests and sleep studies usually require the proper diagnostic codes to get pre-authorized. If you want a stress test complaining of chest pain will usually do the trick. There are specific reasons that will get a sleep study approved. The big one is if the person has excessive daytime somnolence or falls asleep inappropriately during the day. Examples can be along the lines of falling asleep while at a stop light while driving a car or perhaps while watching TV. If a sleeping partner is with the patient and reports apneic (stop breathing) spells during the night or loud snoring that is included with the sleep study request. If the patient has evidence of pulmonary hypertension on a prior echocardiogram I list that as a diagnosis. Sometimes I have to dictate a letter to the insurance company explaining the reasons. Getting tests can be risky for a pilot due to the consequences of an abnormal result but if you are going the need one anyway it helps to know what magic words will get the test approved.

 

[Jeff Oslick]

Getting tests can be risky for a pilot due to the consequences of an abnormal result but if you are going the need one anyway it helps to know what magic words will get the test approved.

So if the patient has none of the symptoms, they need to lie about that to get the test covered under insurance. Then the "symptom" would be on the record for the FAA, regardless of the outcome of the test, so you're still probably screwed with the FAA. Nice system.

 

[Gary F]

So if the patient has none of the symptoms, they need to lie about that to get the test covered under insurance. Then the "symptom" would be on the record for the FAA, regardless of the outcome of the test, so you're still probably screwed with the FAA. Nice system.

Wait a minute. I never advised anybody to lie about anything. I'm telling you how the system works. A lot of physicians and patients game the system. I am not willing to do that and I suffer significant financial consequences. When I negotiated my current employment contract I insisted on a 10% cut in base salary so I would not be under pressure to overproduce.

 

[Jeff Oslick]

Gary,

I didn't mean to imply that *you* were advocating lying. Sorry if it came across that way.

Jeff

 

[Matthew]

Tossing this out... For those who've done a sleep study, does "typical" insurance cover any of it?

I don't know if there us such a thing as "typical" anymore. Mine did, but that was nearly a decade ago. I would expect insurance to cover it, like any other lab work. It'll probably require some sort of referral from your PCP, and be subject to whatever your deductible is.

 

[bbchien]

So if the patient has none of the symptoms, they need to lie about that to get the test covered under insurance. Then the "symptom" would be on the record for the FAA, regardless of the outcome of the test, so you're still probably screwed with the FAA. Nice system.

You are just tooooo negative, man. if you tell the doc you have rest issues, he'll order the test, then if negative, it works out superbly for everyone, including you.....

get a grip