Diagnosing and treating a sleep disorder is pivotal to your health and well-being. That being said, the process of getting the necessary treatments and diagnosis can make patients apprehensive if they do not know the costs that are ahead. Health insurance can be complicated, especially when it comes to understanding a new-to-you treatment like CPAP therapy. Today, we will talk about what you can do to save money, how to get good treatment and how to work with your insurance to cover the costs.
Getting Diagnosed: First Steps
Many are surprised to learn that they cannot buy a CPAP machine without first getting a prescription for one from a doctor. These machines aren’t the type of medical device that people can really abuse, in fact, it can be a challenge for some users to stay compliant. Nevertheless, a visit to the doctor is the first step in getting your diagnosis.
You are going to need to make an appointment with your doctor to discuss the symptoms you are experiencing that lead you to believe you may have sleep apnea. Some common symptoms of a sleep disorder are:
- Fatigue
- Depression
- Snoring
- Irritability
- High Blood Pressure1
- Sexual Dysfunction
- Lack of Concentration
If your doctor believes you are presenting symptoms of a sleep disorder, they will refer you to have testing done to confirm and diagnose the root cause. It will likely be an option of two different tests, depending on your needs. It would likely either be an at-home sleep test or an overnight study in a sleep center. If you want specifics on the differences between the two, click here. These are the different types of sleep tests performed:
- In-Center PSG (Polysomnography) – The general sleep study/baseline
- Split Night PSG (50/50 or Split)
- Titration Study
- HSAT or HST (Home Sleep Apnea Test)
- MSLT (Multiple Sleep Latency Test)
Dr. Mostafavi says this of Advanced Sleep Medicine’s Sleep Center, “We make our in-center sleep studies cozy to ensure you have a normal sleep to get accurate testing.” Once your results are in, your doctor will meet with you to discuss the course of treatment best suited to your needs. If it is deemed medically necessary, you should be authorized to have some coverage for a CPAP machine.
How Your Doctor Can Help Keep Costs Low
Unfortunately, out of pocket expenses are on the rise, but there are certain steps your doctor can take to help keep costs low. However, it’s important to remember that in the long run, it can cost less to make the investment in your health now than be faced with the expensive outcome of untreated sleep apnea.
Your doctor will suggest whatever treatment option they think is best for you regardless of cost, as this is the proper standard of care. However, they can and should also provide alternatives to you that will help to fit your budget. For example, an at-home sleep test is going to be less expensive than staying the night at a sleep center. If you are a good candidate for an at-home test, this will be an option to try.
If after a study, they have ruled out the possibility for obstructive sleep apnea (OSA), they may recommend an oral appliance to help with snoring. This is a less expensive treatment option than surgery to aid the upper airway. If you are showing mild symptoms of a sleep disorder, they may even suggest simple lifestyle changes like adopting a healthy diet or quitting smoking. Both of these are low cost and free.
If you do have OSA and require a sleep machine, your doctor will be able to recommend lower cost items and will stress the importance of compliance in order for insurance to keep paying their contribution.
How to Work With Your Insurance Provider
Each person’s insurance plan can vary, so it’s important to know how to work with your provider.
HMO
An HMO stands for Health Maintenance Organization. They have their own network of providers in which they provide coverage. If you choose a provider outside of this network, you will pay a substantial amount more. Before you seek treatment, call your provider to see that you are going to a facility that will be covered. HMO insurance plans require authorization. Once your insurance has been properly authorized, you can have a sleep study. Deductibles and co-payments may still apply.
Medi-Cal HMO
This is health insurance coverage for those with low income. In order to be prepared, call your provider to see what criteria need to be met in order to qualify for a sleeping aid like a CPAP machine. Likely, this will first be a physical exam followed by an at-home sleep test if possible.
PPO
PPO stands for preferred provider organization. They are typically the most popular plans, due to their ease of use and coverage. Even still, these providers require authorization before beginning a sleep study. These plans usually allow for a new mask every 30 days if you are compliant with treatment. Your out of pocket expense will vary depending on which plan you have, but most PPOs offer some form of coverage or another for the machine and supplies. Deductibles and co-payments may still apply.
Medicare
Medicare is a federal health insurance program for those 65 and older. Medicare will also require authorizations for both sleep studies and a CPAP machine. If you have been diagnosed with sleep apnea, Medicare will allow a three month trial period of CPAP therapy. This trial will be extended if you are able to say the therapy has helped you and that you have been compliant. These factors can be dependent on the cost.
Often, many insurance companies will rent out the equipment on a monthly basis. These are the basic terms followed:
- 3-month rental, 4th-month purchase (many PPO insurances)
- 10-month rental (most HMO insurance and some PPO insurances)
- 13-month rental (Medicare and other government insurance)
Call your provider to see what options are available to you and what your potential financial responsibility may be. Furthermore, it’s important that when and if you get coverage, you are compliant with your CPAP treatment. This means utilizing therapy for four hours each night. If your insurer does not see improvement in your symptoms or that you are not utilizing the device as prescribed, it is likely not going to be covered any longer. These are some reasons it can be taken away and why it is so important to remain compliant with your health and treatment.
The Importance of Treatment
It’s understandable to have concerns about paying for a diagnosis and treatment. Unfortunately, taking care of yourself isn’t always synonymous with low cost. However, to not take care of treating your sleep apnea results in costs that are too high to pay, financially, emotionally and physically. Some consequences of untreated OSA are an early onset of dementia, heart attacks2, strokes and diabetes3 . These extreme cardiac events and diseases can cost more long term than it would cost to treat sleep apnea, potentially preventing or eliminating the issues altogether.
As we all know, insurance cannot go overlooked when it comes to a health concern. Contact us for more information on your coverage for sleep studies today!
- Phillips, B. (2008). Prevalence of Symptoms and Risk of Sleep Apnea in the US Population: Results From the National Sleep Foundation Sleep in America 2005 Poll. Yearbook of Medicine,2008, 319-321. doi:10.1016/s0084-3873(08)79227-7
- Journal of the American College of Cardiology, August 2008, “Sleep Apnea and Cardiovascular Disease”. http://www.onlinejacc.org/content/52/8/686
- “The Link Between Sleep Apnea and Diabetes.”https://www.sleepdr.com/the‐sleep‐blog/the‐link‐between‐sleep‐apnea‐and‐diabetes/
Comments
Marian Budzynski-Moldan
Posted on October 10, 2019What is the difference between the cost to insurance when the Place of Service is an inhome sleep study vs. oncampus outpatient hospital sleep study?
Mischa Brooks
Posted on July 01, 2021Very informative blog post. Keep it up!
SANDY MOSER
Posted on October 16, 2021Hello, I am just wonder what I would need to do to get a new cpap machine when mind goes bad and have the insurance paid for it, I have not be to my lung dr. for about 4 years, I have just been replace the mask and hose on my own without using insurance, I do go to a primary care Dr.
I will be going on medicare in aug. of 2022.
My machine is still working fine, at this time, would I have to do another sleep test to get insurance to pay? Would I have to go to a ent or lung dr. to get insurance to pay? Or will my primary Dr be able to help with this? Thank
Charles M Honeycutt
Posted on January 06, 2022Where can I get reasonably priced supplies like a mask, headgear, and heated tubing and Medicare or Cigna will pay for them. Rotech is gouging on prices charging $255.00 for full face size 20L face mask. Insurance paid them $128.66 and they expect me to pay $102.93. Tubing and headgear is also overpriced and I am expected to pay the difference.
Leah Olsen
Posted on March 02, 2022Many are surprised to learn that they cannot buy a CPAP machine without first getting a prescription for one from a doctor.
Flappy Bird
Posted on May 16, 2022Flappy Bird is an arcade game with very simple mechanics but presents a very difficult challenge. Please visit my website to experience it.
Hope you Like the Game.
free solitaire
Posted on June 29, 2022Even me. Once I fall asleep, I dream till I wake up. Some dreams are too weird to share. Want a dreamless night. I once slept like blinking and I miss it.
fall guys
Posted on August 31, 2022I have been using the phone for a while and I can say that it makes the job very easy.
wordle online
Posted on August 31, 2022I strongly recommend buying a separate phone, especially if you have your own business.
slope game
Posted on October 05, 2022The information you have posted is very useful. The sites you have referred was good. Thanks for sharing.
io games
Posted on October 12, 2022This tool looks very strange and beautiful. To create it takes a lot of time. I hope your game will be enjoyed by you
trap the cat
Posted on October 13, 2022Spend some time playing. I’m interested in finding out more because I have strong views about it. Would you please provide more details to your blog post? We will all actually gain from it.
Air Fryer
Posted on November 20, 2022Nice post
Best Sms Scheduler App
Posted on December 14, 2022Nice post
Samuel T. Cramer
Posted on March 31, 2023Well Said & Great Info About that!
PikaShow IOS
Posted on April 04, 2023Great post. I would love to learn more of this stuff from your end
ARUN VIRAT
Posted on April 07, 2023Wordle is an online word game that was created by Jonathan Feinberg in 2008. The game’s objective is to guess a five-letter word in just six attempts. The game will give you feedback on each guess, showing you which letters are correct and in the right position
ARUN VIRAT
Posted on April 07, 2023CBSE result. The Central Board of Secondary Education (CBSE) is responsible for conducting exams for students in grades 10 and 12.
Pikashow for iOS
Posted on April 19, 2023The great app to watch entertainment content on your iOS, iPhone and on apple devices using the Pikashow app. Let’s try it on your iOS.
Friday Night Funkin'
Posted on April 28, 2023Insurance coverage for sleep studies, sleep apnea, and CPAP (continuous positive airway pressure) treatment can vary depending on the insurance plan and the specific medical situation of the patient.
Gutter specialists
Posted on May 17, 2023Good read. I like how you talked about how our doctor can keep costs low. I think that will help a lot of people who suffer from this.
Kepala Bergetar
Posted on June 01, 2023Thanks for sharing this useful information here.
Kepala Bergetar
Posted on June 11, 2023Kepala Bergetar Tonton Malay Drama Dan Melayu Telefilem, Mega Drama HD Video, Tonton Cerekarama dan Download Drama Akasia Pencuri Movie Live Episod Terkini Telefilem myinfotaip Senrai Drama myflm4u Video.
Kepala Bergetar
Posted on June 19, 2023Thanks for sharing.
Petspaa
Posted on June 23, 2023Did you know that owning a pet can actually help humans improve their fitness levels? It’s true! Check out this informative article on the top 10 benefits of owning a pet for detailed insight. Discover how our furry friends can inspire us to prioritize our health and well-being while enjoying the wonderful companionship they offer. You can find the article here.
pika show apk
Posted on June 29, 2023pikashow Apk is an Android based application that provides users with access to a vast collection of movies, TV shows, and live TV. Its user friendly interface, compatibility with multiple devices, and regular updates make it an excellent choice for users looking for a convenient and affordable way to access movies and TV shows. Pikashow is a streaming platform that provides its users with access to a wide range of movies, TV shows, and live sports events. The platform offers a user friendly interface and allows users to watch their favorite content without any interruption or buffering.
pikashow app
Posted on July 12, 2023The great app to watch entertainment content on your iOS, iPhone and on apple devices using the Pikashow app. Let’s try it on your iOS.
kepalabergetar9
Posted on July 25, 2023What are the available insurance coverage options for sleep studies, treatment of sleep apnea, and CPAP machines?
neverendservices
Posted on July 31, 2023Nice Post
Mumbai Dating Girls
Posted on July 31, 2023Great article! I love your informative writing style and how you make complex ideas accessible.
Truecaller downloads apk
Posted on August 01, 2023Great websites for calls and also for Tv shows.Truecallermodapk provides best information about live streams and best for calling.
Mumbai Companion
Posted on August 03, 2023This is a very useful article and only a few websites on the internet provide such valuable content. I would love to find more of this kind of content from your end.
Thops TV APK
Posted on August 07, 2023It is important to note that ethical considerations play a significant role in THOPSTV’s operations. The platform takes care to ensure that it complies with copyright laws and respects intellectual property rights. This commitment ensures that the content provided to users is authorized and sourced from legitimate channels.
Mumbai Models
Posted on August 08, 2023Nice Article.
Diksha
Posted on August 08, 2023that was awesome info. but check ethics.
Reddy
Posted on August 09, 2023Thank you very much for your valuable inforamtion
Ring Ring Apk
Posted on August 09, 2023Now i have understand how to Take insurance coverage for the sleep studies thank you very much for you Inforamtion
chat gpt login
Posted on August 12, 2023Good job keep posting good stuff
chat gpt login
Posted on August 12, 2023Brilliant information thank you so much
Mumbai Models
Posted on August 14, 2023Very Nice Blog.
Mumbai Companion
Posted on August 16, 2023Nice Post
Russian Danting Girl
Posted on August 22, 2023My name is Neha from Kolkata. Anyone meet me for fun and pleasure?
Mumbai girls
Posted on September 02, 2023Thanks For Posting
Nikitabangalore
Posted on September 02, 2023Nice post
Mumbai Girls
Posted on September 04, 2023Nyc post
hyderabadbeauties
Posted on September 05, 2023Appreciated without a doubt
Myfitway
Posted on September 12, 2023this is very informative and helpfull to me, thanks for sharing
Anita giri
Posted on September 12, 2023your post are very helpfull for us…
faiz
Posted on September 14, 2023With the help of this article, you have given very good information to all of us, this information can be very beneficial for us. thanks for giving such good information.