Insurance covers sleep study - minus CPAP titration???

samofny · Post by **samofny** » Wed Sep 19, 2007 5:34 am

My insurance company covered two nights at the sleep clinic, plus all my CPAP equipment. Yet, they did not cover the CPAP titration. So now I have to pay $400. Why do they think that CPAP titration is something special and not part of the sleep study?

Slinky · Post by **Slinky** » Wed Sep 19, 2007 6:23 am

Sam, may I ask why you spent two nights at a sleep clinic and then a third night for the CPAP titration?

Usually you will spend one night sleeping (hopefully) at the sleep clinic for sleep evaluation and then the second night sleeping (hopefully) at the sleep clinic is the CPAP titration.

I slept almost 6 hours the night of my sleep evaluation - but - I was very lucky (I thought) when I slept so badly and so little the night of my titration study (only 42 minutes out of 6 hours) that they had to bring me back in for a second titration study (when I only slept 98 minutes out of 6 hours) and I was sweating whether Mediacare would pay for that second titration or that my secondary insurance would pay its share of the second titration study - but, thank God, they did!

I was put on CPAP after the second titration but had difficulties for the next 3 months so my sleep doctor finally ordered a loaner autoPAP to try to titrate my pressure better with my sleeping at home in my own bed. Which it did. My pressure was raised 1 more cm and that seems to have done the trick.

Many times the insurance coding can make a big difference in whether our insurances pay for a procedure or not and it "might" be, if there was a good reason for a second sleep study before doing a titration that your insurance would reconsider and pay. But I wouldn't get my hopes too high. Given the costs of a sleep study ($1550 per night in our area) I suppose one should be grateful that $400 was all you had to pay for a second sleep study! You might try talking to your sleep lab manager about this to see if some adjustment or negotiation can be arrived at. Nothing ventured, nothing gained.

Good luck.

Pam · Post by **Pam** » Wed Sep 19, 2007 6:44 am

You should have the sleep study billing depart to rebill your insurance. They probably put in the wrong code or something else.

That has happened to me on other tests and once they bill the insurance correctly it gets paid.

Good luck
Pam

samofny · Post by **samofny** » Wed Sep 19, 2007 8:21 am

Pam wrote:You should have the sleep study billing depart to rebill your insurance. They probably put in the wrong code or something else.

That has happened to me on other tests and once they bill the insurance correctly it gets paid.
Pam

That's exactly what happened; they put in the wrong address which had them show up as out of network. They are sending it in again with the correct address.

I only spent two nights at the sleep clinic (that was enough!). I was put on the CPAP on the second night.

Sam

skits · Post by **skits** » Wed Sep 19, 2007 11:08 am

Does insurance usually cover all of the sleep study? My first one was $2767, and so far insurance covered all but $400. I'm guessing (underlined) that the second one I just had will cost the same (this was with the cpap) and I'll owe yet another $400. I think I'm going to have to get full time work to cover all this #$%$#%.

cflame1 · Post by **cflame1** » Wed Sep 19, 2007 5:30 pm

depends on your insurance... if it's an 80/20 policy it won't cover it all... and some policies won't cover it at all.

RosemaryB · Post by **RosemaryB** » Wed Sep 19, 2007 8:56 pm

[quote="skits"]Does insurance usually cover all of the sleep study? My first one was $2767, and so far insurance covered all but $400. I'm guessing (underlined) that the second one I just had will cost the same (this was with the cpap) and I'll owe yet another $400. I think I'm going to have to get full time work to cover all this #$%$#%.

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