Sleep studies are tests that watch what happens to your body during sleep. Raise your risk of having high blood pressure in the lungs (pulmonary hypertension). Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. To learn more about Healthwise, visit Healthwise.org. Previously it was connected to two places in your body -- the hypoglossal nerve and your ribs. After your sleep problem has been identified, you may need a second study if your doctor orders treatment such as CPAP. 4. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. Navigation Menu - Opens a Simulated Dialog. This causes a little back-pressure in the airways that may help keep them open. Make it harder for people with diabetes to control blood sugar. The Inspire sleep apnea device is aFood and Drug Administration-approved surgical implant that's placed under the skin on your chest. You're right. This information does not replace the advice of a doctor. Take a small overnight bag with personal items, such as a toothbrush, a comb, favorite pillows or blankets, and a book. 1995-2023 Healthwise, Incorporated. Your doctor will probably do a physical exam and ask about your past health. Inspire is a popular alternative to the CPAP machine. I am tired of being attached to a machine at night while I sleep. They are easier and more comfortable for some people to use. Certain things increase your risk for obstructive sleep apnea. However, if you're living with sleep apnea and finding no relief with the usual treatments, the Inspire implant may be right for you. Lead to other problems, such as high blood pressure and heart disease. Consultas sobre citas y consejos de salud : Copyright 2017 Kaiser Foundation Health Plan, Inc. Woodland Hills and surrounding areas (including western Ventura): Antelope Valley: 1-877-554-4404 (TTY 711), Baldwin Park y alrededores: 1-800-780-1277 (TTY 711), Downey y alrededores: 1-800-823-4040 (TTY 711), Fontana, Ontario y alrededores: 1-888-750-0036 (TTY 711), Condado de Kern: 1-877-524-7373 (TTY 711), rea metropolitana de Los Angeles: 1-800-954-8000 (TTY 711), Condado de Orange: 1-888-988-2800 (TTY 711), Panorama City y alrededores: 1-888-778-5000 (TTY 711), Riverside y Coachella: 1-866-984-7483 (TTY 711), Woodland Hills y alrededores (incluido el oeste de Ventura): 1-888-515-3500 (TTY 711). You or your bed partner snores loudly and heavily and feels sleepy during the day. Continuous positive airway pressure (CPAP) is nearly always the first medical treatment for sleep apnea. Kaiser Permanente is not responsible for the content or policies of external websites. Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.,1300 SW 27thSt., Renton, WA 98057, Selecting these linkswill take you away from KP.org. What are the risks of untreated sleep apnea? How does Inspire work? Servicio a los Miembros (rea metropolitana), Servicio a los Miembros (fuera del rea metropolitana) 1-800-777-7902 (TTY 711). Enter X266 in the search box to learn more about "Learning About CPAP for Sleep Apnea". If other members of your family have sleep apnea, you are more likely to have it than someone who doesn't have a family history of it. CPAP side effects may include nosebleeds, a sore throat, and headaches. It may help to go back and read "Get the Facts." Details. But other treatments work almost as well in most people. Or it might take place at a sleep center, where you will spend the night. My doctor said that even if I have the surgery, I still might have to use CPAP. You could try to lose weight, sleep on your side, and avoid alcohol and medicines like sedatives before bed. Your doctor may also help you with problems like swallowing air, bloating, or claustrophobia. around and for a woman whose neck measures more than 16 in. Based on FDA indications and insurance requirements, an Inspire trained doctor will determine if you meet the four criteria. Traditional Health Insurance Medicare Veterans So if you have sleep apnea, you may: When you stop breathing because of obstructive sleep apnea, the oxygen levels in your blood go down and carbon dioxide levels go up. CPAP: If you have a bed partner, they may also sleep better when you use a CPAP. Navigation Menu - Opens a Simulated Dialog, Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine, Request for confidential communications forms. Monday through Friday, Oahu: 7:30 a.m. to 5 p.m. Sign In This is done by having a sleep study. You may not sleep well during the test and may be tired the next day. You're right. Talk to your doctor or pharmacist about your options. 2. Sleep Lab Frequently Asked Questions - Kaiser Permanente It really isn't that much of a bother for me to use. How sure do you feel right now about your decision? Hypoglossal Nerve Stimulation for Sleep Apnea | My Doctor Online These include nasal strips and nasal disks. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Not to mention that battery replacements are needed every 11 years. You might be able to try another type of mask or make other adjustments. Humana Now Provides Coverage for Inspire Upper Airway Stimulation Apnea episodes and snoring may return over time. Tonsillectomy and Adenoidectomy for Obstructive Sleep Apnea and Snoring, Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea, Oral Breathing Devices for Sleep Apnea and Snoring, Request for confidential communications forms. Blocked or narrowed airways in your nose, mouth, or throat can cause sleep apnea. I am tired of being attached to a machine at night while I sleep. Apnea episodes and snoring may return over time. The risk increases for a man whose neck measures more than 17 in. Inspire Therapy Approved for Sleep Apnea Patients at Military and VA They check for how often you stop breathing or have too little air flowing into your lungs during sleep. But they may not give the same results as a sleep lab. Follow us on these external social media sites that will open in a new browser window. Sleep Studies: About This Test | Kaiser Permanente Surgery can sometimes correct the blockage and improve sleep apnea. There are three main types of sleep apnea: Inspire is only for treating obstructive sleep apnea; it will not treat central sleep apnea. Monday through Friday, 8 a.m. to 5 p.m.; Saturday, 8 a.m. to noon, Member Services D.C. metro area1-800-777-7902 (TTY 711), Member Services outside D.C. metro area1-800-777-7902 (TTY 711), Portland: 503-813-2000 (TTY 711)All other areas: 1-800-813-2000, Member Services Portland1-800-813-2000 (TTY 711), Member Services outside Portland 1-800-813-2000 (TTY 711), Member Services outside D.C. metro area, Washington (Vancouver/Longview area) Address, Kaiser Foundation Health Plan of the Northwest 500 NE Multnomah St., Suite 100 Portland, OR 97232, Washington (outside Vancouver/Longview area), Address 601 Union St., Suite. Changing the position of the lower jaw enlarges the airway and decreases the chance that it will collapse when you inhale. Think about what matters most to you in this decision, and show how you feel about the following statements. Because sleep apnea disturbs your sleep, it can make you very tired during the day. To learn more about Healthwise, visit Healthwise.org. Your use of this information means that you agree to the Terms of Use and Privacy Policy. 2. Your use of this information means that you agree to the Terms of Use and Privacy Policy. They also find out how much oxygen you have in your blood during sleep. Do poorly at school or work and have trouble concentrating. Other types of surgery that may be used to treat sleep apnea include: Maxillo-mandibular advancement, which moves the upper and lower jaw forward to increase the size of the airway. ", "CPAP is doing wonders for my sleep apnea. Some people who have sleep apnea have a small, receding jaw. Sleep Apnea: Should I Have a Sleep Study? The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Register, Medical Review:Kathleen Romito MD - Family Medicine & Adam Husney MD - Family Medicine & Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine. Be safe with medicines. Is surgery usually a doctor's first choice in treating sleep apnea? For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. No, that's wrong. Be sure the mask, nasal mask, or nasal pillow fits well. The Health Encyclopedia contains general health information. 2. Oral or nasal breathing devices may also help. This is repeated muscle twitching of the feet, arms, or legs during sleep. Continuous positive airway pressure (CPAP), Sleep Apnea: How Treatment Can Improve Your Life, continuous positive airway pressure (CPAP), E. Gregory Thompson MD - Internal Medicine, Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine, Continuous positive airway pressure (CPAP) for sleep apnea. I don't like the idea of living with a hole in my throat. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. Kaiser Permanente is not responsible for the content or policies of external websites. For some people, Inspire may be the only real option for relief from OSA. Surgery can sometimes correct these deformities and improve sleep apnea. What is involved in the Inspire procedure and recovery? If you need help with Kaiser Permanente services or have questions, please see the phone numbers by state/area below. Conditions such as periodic limb movement disorder. Taking my CPAP machine on business trips is too much trouble for me. Feeling unrefreshed or tired after a night's sleep. Inspire is an alternative sleep apnea treatment to a traditional CPAP machine. When you stop breathing or have reduced airflow into your lungs during sleep, you don't sleep well and you can be very tired during the day. If your child snores, be sure to tell your doctor. I can't say exactly how much you'll end up paying -- it depends heavily on your insurance plan and deductible. They may also be used for people with severe sleep apnea who find that continuous positive airway pressure (CPAP) doesn't work for them. Here are some things you can try: Talk to your doctor if you're still having problems. In younger children, other symptoms include: In older children, other symptoms may also include: In rare cases, sleep apnea in children can cause developmental delays and failure of the right side of the heart (cor pulmonale). The side effects of CPAP aren't bad enough to keep me from using it. Si necesita ayuda con los servicios de Kaiser Permanente o si tiene alguna pregunta, consulte los nmeros de telfono por estado o rea, tal y como se indica a continuacin. Apnea episodes and snoring may return over time. Simply turn Inspire on before Shop your favorite products and well find the best deal with a single click. 1. Inspire is available for veterans at select VA and military hospitals across the US, Visit the Find a Doctor page or chat with an Inspire Advisor to see if there is an VA or military hospital near you that offers Inspire, If there is not a center near you, you can possibly utilize a program called the Community Care Program. As breathing resumes, loud snoring starts. Enlarged tonsils or adenoids are a common cause of sleep apnea in children, so surgery to remove them is usually the first treatment. Medicines to avoid include sleeping pills, opioids, and sedatives. Sleep apnea tends to occur more often in women who have been through menopause than in women who have not. It may help to go back and read "Get the Facts." Conditions such as periodic limb movement disorder. Problems with nighttime behaviors. It increases air pressure in your throat to keep your airway open. It senses pauses in breathing and adjusts air pressure. Traditional continuous positive airway pressure, or CPAP, machines can be loud, uncomfortable, and have a pesky mask and hose attached to the device. We talked about my having surgery to treat my sleep apnea so I wouldn't have to use CPAP anymore. or Nerve stimulation. If you have a bed partner, they may notice that during sleep you stop breathing, often snore loudly, gasp or choke, or toss and turn. De lunes a viernes, de 8:00 a. m. a 6:00 p. m. Horario Abierto los 7 das de la semana, de 8 a. m. a 8 p. m. Washington (fuera del rea de Vancouver/Longview), Direccin 601 Union St., Ste. Medicare partially covers the cost of a medically necessary CPAP machine as durable medical equipment. CPAP is a machine that prevents your airways from closing during sleep. Follow us on these external social media sites that will open in a new browser window. A tracheostomy nearly always cures sleep apnea. That eliminates an incision and, according to Inspire, reduces the procedure time by 20%. Since I travel a lot, CPAP isn't very convenient for me. Learn how we develop our content. Other things that make sleep apnea more likely include: UPPP: Your doctor may suggest UPPP (to remove excess tissue in your throat) if: Maxillo-mandibular advancement and radiofrequency ablation: Your doctor may recommend one of these other surgical treatments if: Tracheostomy: Your doctor may recommend tracheostomy (to put a permanent opening in your neck to your windpipe) if: These stories are based on information gathered from health professionals and consumers. Some people have both types. You might be a candidate for Inspire if. This information does not replace the advice of a doctor. Problems staying awake, such as narcolepsy. For example, you may have enlarged. The more often it happens, the more serious the apnea is. Does Medicare Cover Inspire For Sleep Apnea? It's important to treat obstructive sleep apnea, because sleep apnea makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke. Oral devices may be used for people who have mild to moderate sleep apnea. Read and follow all instructions on the label. Your doctor will examine you and ask about your past health. cross-references to other topics, definitions or medical illustrations) is only available in the online version. For recommended treatments, please consult with your health care provider. Sleep Apnea | Kaiser Permanente 3. They may be helpful as you make important health decisions. A dentist will shape the device to fit your mouth. Children may need to see a specialist if they have sleep apnea. When you're ready for bed, simply click the remote to turn Inspire on. Does Medicare Cover Sleep Apnea | MedicareFAQ Taylor Leamey writes about all things wellness, specializing in mental health, sleep and nutrition coverage. She has invested hundreds of hours into studying and researching sleep and holds a Certified Sleep Science Coach certification from the. By stimulating the tongue and airway muscles, Inspire aims to treat the underlying cause of sleep apnea, not just the symptoms. PDF Inspire Medical Systems Sleep Services Billing Guide 2021 - Professionals Be ready to talk about your struggles using CPAP and any sleep-related topics including: Write down any questions you have for the doctor, The airway exam is a very routine and non-surgical exam, Youre given a short-acting medication to put you to sleep. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.,1300 SW 27thSt., Renton, WA 98057, Selecting these linkswill take you away from KP.org. The CPAP machine will have one of the following: CPAP is usually the best treatment for obstructive sleep apnea. Most U.S. insurance companies cover Inspire; Over 400 insurance companies have covered the cost of Inspire for patients who meet the eligibility requirements; . Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. Other oral breathing devices supply . CPAP Machine. Disorders that may increase your risk include hypothyroidism and acromegaly. Overview The hypoglossal nerve stimulator (HGNS) is a treatment for obstructive sleep apnea (OSA). Inspire Medical wins more Blue Cross Blue Shield coverage Inspire : r/SleepApnea - reddit Los planes Medicare Advantage no estn disponibles actualmente en la regin montaosa de Colorado. It increases air pressure in your throat to keep your airway open. Adaptive servo ventilation (ASV). Abierto los 7 das de la semana, de 8 a. m. a 8 p. m. Puede llamarnos las 24 horas del da, los 7 das de la semana, al: Despus de las 7 p. m., llame al 1-888-576-6225, de lunes a viernesLlame en cualquier momento los sbados y domingos. To start, let's talk about what sleep apnea is. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Inspire Sleep Apnea Innovation - Reimbursement - Professionals It's a small device placed during a same-day, outpatient procedure. 2023 Kaiser Foundation Health Plan, Inc. We are unable to switch you to this area of care. See if your doctor can adjust the pressure of your CPAP. Your condition is easy to fix, such as very large tonsils. Medicines include some types of sleeping pills, opioids, and sedatives. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. That's because you aren't snoring or restless. Almost all people who have sleep apnea snore. These include: You can also try oral breathing devices or nasal devices. Author: Healthwise StaffMedical Review: Anne C. Poinier MD - Internal MedicineE. Problems with nighttime behaviors. Inspire - Obstructive sleep apnea treatment option - VA News Clarksburg VA performs the Inspire procedure, an obstructive sleep apnea treatment that works inside the body with the natural breathing process. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives. Tubing and other supplies for your sleep apnea machine are generally also covered at 80%. This may be the only symptom in some children. Follow us on these external social media sites that will open in a new browser window. If these things don't help, you might try a different type of machine. Sleep studies may be done if your sleep is not restful or if you are tired all day. Inspire Medical Systems, Inc. 2023. Medical Review:E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine. 2023 Kaiser Foundation Health Plan, Inc. We are unable to switch you to this area of care. or This information does not replace the advice of a doctor. Have nighttime choking or gasping spells. This most often occurs because your airways are blocked or partly blocked. Does UPPP always work well for sleep apnea? Snore loudly. Untreated sleep apnea can lead to serious risk of: Treatment options for sleep apnea include: Answer a few short questions to see if you may qualify for Inspire, then connect with a doctor to take the first step toward better sleep. Inspire works inside your body with your natural breathing process to treat obstructive sleep apnea. I have been using continuous positive airway pressure (CPAP) to treat my sleep apnea for over a year. Ask your doctor when you can expect to have your test results. Inspire Sleep Apnea Treatment: How It Works - Verywell Health Do you need treatment even if your sleep apnea doesn't bother you too much? To learn more about Healthwise, visit Healthwise.org. Sign In Navigation Menu - Opens a Simulated Dialog. According to the FDA's summary of clinical studies on Inspire, the most commonadverse eventsinclude: Inspire says that most of these adverse events resolve themselves over time, with the use of medication or by adjusting the settings on your Inspire, which the FDA's report also confirms. Even though that might sound intimidating, it's an outpatient procedure. First, the patient must be diagnosed with at least moderate obstructive sleep apnea. Inspire sleep apnea cost: Is the therapy worth for sleep apnea? To get the implant, you must have moderate to severe OSA and not benefit from a CPAP machine. Details. Health Insurance Inspire is covered by most major insurance providers. Your child snores, has trouble breathing while sleeping, sleeps restlessly, wakes up often, or is very sleepy during the day. Despite seeming like a minor annoyance that might keep your partner up at night, there are several serious side effects of sleep apnea if left untreated, including high blood pressure, strokes and heart issues. A Continuous Positive Airway Pressure (CPAP) machine is also known as a respiratory assist device. This device pushes your tongue and jaw forward to improve airflow. Show which way you are leaning right now. I talked with my doctor, and we agreed that surgery might be a good option to treat my sleep apnea. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. Be sure to make and go to all appointments, and call your doctor if you are having problems. Sleep apnea can range from mild to severe, based on how often breathing stops during sleep. Do you have enough support and advice from others to make a choice? Inspire should not limit your normal activities, The current version of Inspire can undergo MRI scans provided specific conditions are followed, Having a pacemaker should not disqualify you from becoming a candidate for Inspire, The current version of Inspire (Model 3028) is eligible for MRI scansprovided specific conditions are followed. I nspire is a brand which manufactures the only Food and Drug Administration (FDA)-approved device for treating obstructive sleep apnea. My nose is always dry, and my sleep is not improving. If you have moderate to severe sleep apnea, you may need to use a breathing device (continuous positive airway pressure CPAP) that prevents your airway from closing during sleep. Sign In You are age 18 or above. Bone deformities of the nose, mouth, or throat can interfere with breathing, causing sleep apnea. You may be able to help treat sleep apnea by making some lifestyle changes. 3. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Medical Review:Anne C. Poinier MD - Internal Medicine & E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine & Lesley Ryan MD - Family Medicine. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. If your sleep apnea doesn't improve with treatment, you may have more tests to find out what's causing it. TRICARE may cover CPAP machines for: Obstructive sleep apnea syndrome. Sorry, that's wrong. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. It's recommended that you turn it on at night and turn it off when you wake up for your day. "A patient's financial responsibility varies based on the specifics of their individual insurance plan," Inspire told CNET. Or try using a humidifier. PDF Frequently Asked Questions - UC Davis What else do you need to make your decision. Like CPAP, an Inspire doctor can print out a usage record of Inspire to show the medical examiner that you are using your prescribed sleep apnea treatment, By proving compliance, there should be no issues renewing your commercial drivers license, A significant decrease in snoring has been found as a secondary effect of Inspire, 90% of bed partners report no or soft snoring by their partner, The battery in Inspire is designed to last for approximately 11 years, Once it is running low, it is replaced during a simple outpatient procedure, Generally, the Inspire system should be checked 1 to 2 times a year. A recent study found that Inspire resulted in a 79% decrease in sleep apnea events. You may find that you want to take off the mask, or you may find it hard to sleep. or Other risks may include: Scar tissue forming at the opening of the hole in your throat. A sleep study may take place in your home. Bone deformities or enlarged tissues block your airways. What are the Operating Hours of the Sleep Lab at South Sacramento Kaiser Permanente? The device sends a signal to the nerve that controls your tongue and upper airway to tighten them while you sleep. Central sleep apnea is caused by a problem with how the brain signals the breathing muscles. Central sleep apnea is less common. The Health Encyclopedia contains general health information. If you get better on your own, you won't need treatment. Phone 844-756-9744 844-756-9744; Chat; Email Spice up your small talk with the latest tech news, products and reviews. Sleep apnea occurs when you often stop breathing for 10 seconds or longer during sleep. It is the first treatment choice and the most widely used. Are you clear about which benefits and side effects matter most to you? It's a small device that operates remotely to help open your airways while you sleep, helping to make you sleep better at night. Most major US insurance companies cover Inspire, An Inspire trained doctor can discuss insurance coverage requirements during an initial consultation, Typically, you can expect to pay any unmet deductible for the year, along with any copay or coinsurance fee for a surgery. A tracheostomy nearly always cures sleep apnea. Decision Points focus on key medical care decisions that are important to many health problems. Excessive snoring. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Register. Problems staying awake, such as narcolepsy. This combats sleep apnea by keeping your airways open. If CPAP does not work, or if large tissues are blocking your airway, you may need surgery. If you will have portable sleep monitoring, your doctor will explain how to use the equipment at home. Sleep labs are often located in hospitals. It delivers mild stimulation to key airway muscles, allowing the airway to remain open during sleep, Inspire is controlled by a small handheld sleep remote, Have been diagnosed with moderate to severe obstructive sleep apnea, Struggle with or cant get consistent benefit from CPAP, Most U.S. insurance companies cover Inspire, Over 400 insurance companies have covered the cost of Inspire for patients who meet the eligibility requirements, Typically, you can expect to pay any unmet deductible along with any copay or coinsurance fee for a surgery, Medicare is covered across the United States for those who meet criteria, Inspire is available for veterans at select VA and military hospitals across the US, Visit the Find a Doctor page or chat with an Inspire Advisor to see if there is a VA or military hospital near you that offers Inspire, If there is not a center near you, you can possibly utilize a program called the Community Care Program, allowing you to receive care at a civilian hospital, To contact Inspires dedicated VA Patient Liaison, email.