Has your doctor ordered a test, medication or specialist visit but can’t tell you what it’s going to cost?
Have you ever been surprised by a huge medical bill when you thought you were covered?
Have you ever postponed a procedure because you weren’t sure what it would cost you?
Have you ever been confused about your insurance coverage for a service that you really needed?
Figuring out the price and your financial responsibility for a sleep study can be a challenge. We’re here to help answer your questions.
Sleep studies don’t have to be expensive.
There’s a big price range depending on the type of sleep study (in-home or in-center), the type of center (do they bill separately for the study and its interpretation?) and your insurance. Most health insurance plans include coverage for sleep studies with certain providers (see the next section below).
An in-center sleep study price tag can range from $500-$3,000. If you have insurance coverage, you choose an in-network provider and you have met your deductible, your financial responsibility may be $0-$150. That’s the average we see (again, read more about deductibles and more below).
For out-of-center of in-home sleep testing (HST), the base rate ranges from $300-$600. If you have insurance coverage, you choose an in-network provider and you have met your deductible, your financial responsibility may be $0-$50.
Here’s a great site clearhealthcosts.com where you can search average costs for medical procedures in each state.
What you need to know about health insurance coverage for sleep studies
The rate you pay for your sleep study depends on the relationship between the sleep center and your insurance company (if you don’t have insurance or elect to pay a cash rate, you can expect to pay anywhere from $700-$3,000 for your in-center study). Your insurance company will contract for services with providers at greatly reduced rates. So it’s important to understand your coverage. There’s a big difference between the price you’ll pay for going to a contracted or in-network provider vs. one who will “accept” your insurance but isn’t contracted. For you, this could mean the difference between paying $150 and $1,200 for the same procedure. We’ve devoted an entire post to this topic here.
You’ll need to know if you have a deductible to meet before your insurance coverage kicks in. For many patients, deductibles can be as high as $2,000 to $4,000 or more. So while you have coverage for the service, you have to pay out-of-pocket until you meet that deductible.
If you’ve met your deductible, your insurance will pay for a covered service, but may not pay 100%. Again, be sure to find out the difference between coverage for an in-network vs. out-of-network provider as in-network coverage could be 80-100% while out-of-network coverage is 50% or none at all. We see typical in-network co-pays are around 20% and end up as a $100-200 charge for the patient (here’s a link to our Guide to Understanding Your Health Insurance).
You should also keep in mind that there may be additional expenses down the road if you are diagnosed with sleep apnea. You may need additional sleep studies or a CPAP (which requires regular replacement of supplies). We talk more about follow-up expenses later in the post. Just keep in mind that all of these expenses will get you closer to meeting your deductible, the point where your insurance will really kick-in and reduce your out-of-pocket expenses.
How to find a contracted sleep study provider
You can always call your insurance company to ask (good luck) or check their member services portal online. Search for “sleep center” or “sleep lab” and make sure to choose the “facility” option. You can also choose facility and search “sleep”.
Or you can search online for local sleep centers (here’s a listing site) and contact them to find out if they are contracted with your insurance. Be sure to ask if they are in-network. Be very clear and ask for a clear answer. You should ask the sleep center to verify your insurance and give you an estimate of your financial responsibility.
We have a full list of all of the insurance plans and medical groups that we are contracted with for all services. You can download it here.
Alternatives to an overnight in-center sleep study
Out-of-center sleep apnea test, aka home sleep test (HST)
This is a self-administered option for patients without other major health condition who want to diagnose or rule out sleep apnea. HST cannot test for any other sleep disorders and may sometimes lead to an in-center test anyway. Some insurance companies are denying in-center testing in favor of HST because it is much less expensive and can sufficiently diagnose sleep apnea in most patients. Learn more about HST here.
If your doctor suspects that you suffer from sleep apnea and you are overweight or obese, losing weight may help to reduce or eliminate sleep apnea. Losing weight may be one solution, but it takes time and is a challenge for many people. While you are trying to lose weight, you may wish to treat your sleep apnea at the same time. This is really important stuff here, so please talk to your doctor.
Doing nothing is also an option. We’ve spent a lot of time talking about the consequences of untreated sleep apnea to your heart, brain, diabetes, reproductive system, relationships, family life and overall life satisfaction. If you don’t treat your sleep apnea there are serious consequences. You will end up paying in the long run.
What expenses to expect AFTER your sleep study
If you’re diagnosed with a sleep disorder, like sleep apnea, there may be additional expenses that you should expect. First, depending on what type of sleep study your physician orders (learn more about the different types of sleep studies here) you may need to return for a second overnight sleep study to determine the optimal pressure settings for CPAP therapy (learn more about CPAP therapy to treat sleep apnea here). In some cases, you can skip the in-center titration and opt for a CPAP device that adjusts the pressure setting throughout the night (learn more about APAP here), but this may not be appropriate for you depending on the severity of your disease and other factors.
If you are prescribed CPAP therapy (this includes APAP or bi-level/BiPAP) you can expect to have to pay for either the purchase or rental of a new device (learn more about insurance coverage for CPAP here). Additionally, the accessories that come with the machine- the mask, cushion, tubing, filters and water chamber- need to be replaced at regular intervals which your DME company can ship to you at regular intervals, usually every three months (learn more about when to replace your supplies here).
The scariest thing about a sleep study for most people is not knowing what to expect you’ll have to pay. Sleep studies can be expensive but they don’t have to be. Understanding your health insurance coverage and your options for testing (in home vs. a sleep center) can help you make a decision that fits your budget. And don’t forget that the cost to your health of doing nothing at all may be the most expensive decision you’ll ever make!
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