medicare pay for sleep study in lab

I really think my sister has sleep apnea. She wakes up all during the night. She lives alone so there is no one to see if she stops breathing. I suggested she get tested. Her doc sent a home sleep study with her and said she does not have it. She does have other health issues she has had about 4 strokes, thyroid issues and afib. She complains a lot about not sleeping good at night and just wants a good night sleep. She is on Medicare and I guess they wont pay for a study in a sleep lab. Is there anything she can do to get Medicare to pay for one? I have had sleep apnea for 10 years and have a CPAP machine which really helps me. Any suggestions would be appreciated

Medicare will pay for a home study (probably already did in this case) and they are usually fairly accurate depending on how comprehensive of a test.
Do you know what type of test was done?
Like just something on her finger or more stuff on finger, nose, chest, etc?

If Medicare has paid for the home study and it didn't show sleep apnea it's highly unlikely that Medicare will want to approve or pay for an in lab sleep study without going through the appeals process and having the doctor on board.

Yes, Medicare pays for lab sleep study. I just had one. If you qualify, they pay for treatment, too.

It's possible the doc ignored the Medicare specs, which have much lower benchmarks for treatment if you've had a stroke.

This doctor is trouble.

Here are readable Medicare specs:

https://www.cms.gov/Outreach-and-Educat ... 905064.pdf

Look at B 2 b.

This board can help you with what those numbers mean.

Not to make sibling trouble, but are you certain your sister complied with the home sleep test?

don't know for sure that she complied because I was not there. I will ask her exactly what the test involved. Thanks for help

blueeyes wrote:don't know for sure that she complied because I was not there. I will ask her exactly what the test involved. Thanks for help

Also get the name of the place that offered the test if you can. An in lab test is better because there is someone there to help when things go wrong. The down side is you have to sleep for a min. of 120min. to get a dx for Medicare to cover equipment and therapy. Some people have trouble sleeping when away from home.

I think a lot depends on how the doc documents the need for a test. The suggestion to find another doc is right on, a sleep doc would be preferred.

Does she have Medicare "Advantage"?
If so, nothing would surprise me.

Medicare pays for sleep studies either in an accredited lab or an approved home sleep study. Medicare doesn't care which, but your sister's supplemental insurer might. Some supplemental insurer plans and Advantage plans (e.g. Kaiser) will only cover a home sleep study unless more complex problems are identified that warrant an in lab study.

But here's the question: Did she really have an approved home sleep study or did the doctor just order a home oximeter test as a screening tool--it clips on one finger and reads oxygen desaturations during the night??? That is NOT the same as a home sleep study and does not count for Medicare. If that turns out to be all she has, then Medicare has not paid for a sleep study and she might be able to push her doctor into ordering one just to be certain it's not some issue that disturbs sleep but is not Obstructive or complex apnea (e.g. RERA).

Due to a mistake on the part of my first doctor, I ended up having four sleep studies in an eight month span. All were paid for by Medicare. All sleep studies were conducted in a sleep lab. My wife ended up having three sleeps studies paid for by Medicare. Obviously, Medicare will pay for more than one sleep study if directed by a doctor.

Seconded about bluecrap. When they were my insurer (at work),
they did enough slimy things that I never considered them as a Medicare supplement.
BCBS and UHC both PERMANENTLY off any list of mine!
(See, I agreed with a correct statement)

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