Health Insurance Coverage for Sleep Apnea
Sleep Apnea Specialist | Serving Vancouver WA and Portland OR
The majority of today’s health insurance companies does pay for sleep apnea studies. This includes PPOs (Preferred Provider Organizations), HMOs (Health Maintenance Organizations), POSs (Point of Service Plans), HSAs (Health Savings Plans), HDHPs (High Deductible Health Plans), and Medicare Part B. That said, the amount that an insurance company will pay depends on a number of variables.
The most prominent variables across insurance plans that policy holders need to understand are:
- Does the policy require an in-home sleep study before it will pay for a clinic or in-lab sleep study?
- Does the policy require a physician’s referral before a study is performed?
- Does a sleep study need prior insurance approval before it is done?
- Does the plan only pay in-network providers for sleep apnea studies and supplies?
- Does the plan require an annual deductible amount be paid before it will pay for services?
- Does the plan require co-insurance payments for studies and supplies?
- Does the plan require co-payments for sleep apnea studies and supplies?
- Does the policy holder have an annual out-of-pocket expense limit that must be satisfied before the
- plan will pay for services?
Does Your Insurance Cover Sleep Apnea Testing?
Policy holders should never take for granted that their policy plans cover all physician recommended medical services. If a patient is referred to a clinic or laboratory for a sleep apnea study, the patient needs to confirm with either their insurance company or the sleep study group that (a) the provider of the sleep apnea study is an in-network provider approved by the insurance company, and (b) what amount, if any, the policy holder will be responsible to pay. The majority of clinics and laboratories work with the insurance companies, on behalf of the referred patients, to assemble all of the required medical reports and to fill out all of the documentation necessary for each step of the study.