If you suspect that you have sleep apnea and need to see a doctor about your symptoms, we suggest that you first check your insurance policy before making any appointments. You may be required to get a referral to a sleep specialist from your primary care physician and/or you may be required to go to a certain testing facility. In some cases, your primary care physician orders the tests and receives the results for you. Keep in mind that you will be tested in a sleep center or laboratory or in a hospital outreach location. Some insurance policies require specific consultation or procedures. You could undergo a "split-night" study in the sleep lab. (During a split-night study, the first half of the night is the testing phase. If the study shows you have sleep apnea, during the second half of the night you begin treatment for sleep apnea.)
Some insurance policies specifically exclude coverage for the diagnosis and/or treatment of sleep disorders and some do not cover durable medical equipment including CPAP machines (the most common form of treatment for sleep apnea is considered durable medical equipment or DME). These are points to consider when examining your policy and whenever thinking about changing your policy (such as during your employer's open season).
Insurance coverage varies for every individual and can even change over the course of a year for the same individual, depending on deductibles and other factors. It is very important to have your benefits verified for every new service before services are obtained. Payment for all services is the sole responsibility of the individual, regardless of insurance coverage.
Depending upon where you live and the provider you see, the diagnosis and treatment of sleep apnea can be a significant expense, usually over $1000, but, even without insurance coverage, when you consider the possible consequences and costs of untreated sleep apnea, being diagnosed and treated properly could be well-worth the price.
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. We have staff that are trained to help you by calling your insurance company concerning your individual insurance benefits, so that you can have a better idea of what your particular policy will cover and what your approximate out of pocket costs should be.