Sleep study ripoff

[Jim Smith]

Just curious to how much others have payed for sleep studies and how much insurance has covered. My girlfried had it done several months ago, they charged $5700, insurance's allowable was $360 which the hospital accepted and wrote off the rest. The next study done while connected to cpap was basically the same amounts.

Now 6 months later the doc sends her to a neighboring facility at a different hospital to have the original test done again to see if cpap is still needed. No reason given for the change in locale. They charge over $14000. Thats right, one night, standard study $14grand. Same insurance company gives this place a $4300 allowable. The hospital writes off the rest.

The problem is her insurance plan at work changed to a $5000 deductable a month before the last test. So the $4300 comes out of our pocket. No notice or warning from the doc (who I'm sure got a nice kickback), the hospital, no-body. Buyer beware I guess. $4300 out of pocket so they can determine if insurance needs to continue a $1500 lease on our cpap.

Not sure how the same insurance company allows $360 for one and $4300 for the other, for the same test. We are still in shock and awe pahse and don't have all the details yet. Just needed to post to get other's feedback. We can't begin to afford this and don't plan on paying a single dime. This is an insane ripoff. She is prepared to allow it to destroy her credit and let them take us to court if they are so inclined.

[TXLadybug]

Call the financial office at the hospital and discuss this with them. Once they find out that this is coming out of pocket, they are highly, highly, likely to work with you both on reducing the balance, and in setting up a reasonable payment plan. You'll find out that they'd much rather work with people who are honest and want to pay a reasonable fee for their services, than someone who ignores the problem, because they think it's too big to tackle.

[ScrappinMom]

Not sure how the same insurance company allows $360 for one and $4300 for the other, for the same test.

I know exactly how it happened...Hospital B has a much better contract negotiator.

Yes, definitely call the hospital. This is what I would do...call the hospital, (don't tell them who you are) and ask what the cash price is for a sleep study. If it's reasonable, tell them that is what you will pay. Alternately, you could offer the Medicare allowable. Medicare allows about $850 here, which I think is more than what it is really worth. $4300 is absolutely absurd. You didn't list your state in your profile, but if you would like the Medicare allowable for your state, PM me and I will direct you to it...it's public info.

Good luck.

[Wulfman]

Just curious to how much others have payed for sleep studies and how much insurance has covered. My girlfried had it done several months ago, they charged $5700, insurance's allowable was $360 which the hospital accepted and wrote off the rest. The next study done while connected to cpap was basically the same amounts.

Now 6 months later the doc sends her to a neighboring facility at a different hospital to have the original test done again to see if cpap is still needed. No reason given for the change in locale. They charge over $14000. Thats right, one night, standard study $14grand. Same insurance company gives this place a $4300 allowable. The hospital writes off the rest.

The problem is her insurance plan at work changed to a $5000 deductable a month before the last test. So the $4300 comes out of our pocket. No notice or warning from the doc (who I'm sure got a nice kickback), the hospital, no-body. Buyer beware I guess. $4300 out of pocket so they can determine if insurance needs to continue a $1500 lease on our cpap.

Not sure how the same insurance company allows $360 for one and $4300 for the other, for the same test. We are still in shock and awe pahse and don't have all the details yet. Just needed to post to get other's feedback. We can't begin to afford this and don't plan on paying a single dime. This is an insane ripoff. She is prepared to allow it to destroy her credit and let them take us to court if they are so inclined.

Why would they have done the second sleep study? You mentioned a change in locale, but not the reason for a second study.
Did they come up with a titrated pressure and give her a prescription (for a CPAP machine) from the first sleep study?

Just think how many data-capable CPAP/APAP machines (and software) could have been purchased with what you're now faced with paying.

Something doesn't make sense.


Den

[Jim Smith]

Just curious to how much others have payed for sleep studies and how much insurance has covered. My girlfried had it done several months ago, they charged $5700, insurance's allowable was $360 which the hospital accepted and wrote off the rest. The next study done while connected to cpap was basically the same amounts.

Now 6 months later the doc sends her to a neighboring facility at a different hospital to have the original test done again to see if cpap is still needed. No reason given for the change in locale. They charge over $14000. Thats right, one night, standard study $14grand. Same insurance company gives this place a $4300 allowable. The hospital writes off the rest.

The problem is her insurance plan at work changed to a $5000 deductable a month before the last test. So the $4300 comes out of our pocket. No notice or warning from the doc (who I'm sure got a nice kickback), the hospital, no-body. Buyer beware I guess. $4300 out of pocket so they can determine if insurance needs to continue a $1500 lease on our cpap.

Not sure how the same insurance company allows $360 for one and $4300 for the other, for the same test. We are still in shock and awe pahse and don't have all the details yet. Just needed to post to get other's feedback. We can't begin to afford this and don't plan on paying a single dime. This is an insane ripoff. She is prepared to allow it to destroy her credit and let them take us to court if they are so inclined.

Why would they have done the second sleep study? You mentioned a change in locale, but not the reason for a second study.
Did they come up with a titrated pressure and give her a prescription (for a CPAP machine) from the first sleep study?

Just think how many data-capable CPAP/APAP machines (and software) could have been purchased with what you're now faced with paying.

Something doesn't make sense.


Den

Thanks for all the feedback so far. They have performed three studies. The first study was the initial diagnoses. The second was to set the pressure for the now prescriped cpap. The third at the new locale was was the doctor's idea due to her losing 30 pounds in the now 9 months since the last study to see if she still had sleep apnea.

And thanks you ScrappinMom. We live in PA

[jweeks]

Hi,

Did you call around to various sleep clinics to check on prices? I did, and found that they vary widely. I ended up at the heart center for a very large urban hospital here in the suburbs of Minneapolis. They quoted me a rate of $2800 for a sleep study, and offered a 45% discount if I paid by credit card at the time of admission. My net cost was around $1500. The lung clinic was slightly more, but only offered a 20% discount for self-pay. What I have found typical is that I can buy the services and equipment as a self-pay with prices less than what the insurance co-pay would be. I have also heard that there can be long waits for sleep studies. What I found is that slots on Sunday nights were available with almost no wait time--I was able to get in the same week that I called for the appointment.

-john-

[artpenjr]

Hi Jim,

Yes, sleep studies are a ripoff, a complete ripoff if you ask me. Mine was over $5,000 at a local hospital, and insurance paid around $4,300. I couldn't sleep at first, and only slept for about 30 minutes before before being awakened and told I had severe sleep apnea. The next 3 hours were titration (sp?) with cpap. One technician, one room, 9pm-6am, 5 grand. Ripoff is right!

My doctor fees were $400 themselves, and insurance paid about $360 of it. Are you sure the price of your first visit was the whole fee paid, and not just the doctor portion?

In any case, yes I would call the second facility and discuss their huge fee for the second test. If they hold the line on the amount, I would call the local newspapers and invite them to look at the bill for the sleep study. Right now is a great time to get some media attention to medical ripoff's. Good luck and let us know how you make out.

Art

[Maryland_Mike]

Yowza, my sleep study was $400. I haven't gotten the bill for the second one yet -- I hope it doesn't come in at the high prices quoted above. I paid about $120, with insurance paying the rest. This was at the main hospital here in Annapolis, MD.

[BlackSpinner]

There is no reason for these kinds of sleep studies to be done repeatedly in a lab setting, especially not for titration! Next time ask for an in home study. They send you home with a special apap, oximeter and recording info. You bring it back the next day and some clerk runs the data through a computer and faxes it to the sleep doc. At that price you could have bought a top of the line APAP, oximeter, scanner and software and done it your self.

[ScrappinMom]

Jim,
For "Metro Philadelphia", regular sleep study Medicare Part B Allowable is $842.73; with titration it's $927.77.
For "Rest of Pennsylvania", regular sleep study is $722.78; with titration is $795.68.

Hope this helps. Good luck.

[pitrow]

wow, I don't feel so bad now. My sleep study was quoted as costing $1,200 total. $40 co-pay at the time and the rest was sent to my insurance. I'm expecting that I'll have to pay all of my $1000 deductible on it and the insurance to cover the rest, but we'll see what happens. $14,000 for a sleep study? That's f-in ridiculous!

[williamco]

so they can determine if insurance needs to continue a $1500 lease on our cpap.

does the insurance pay $1500 monthly or yearly to lease CPAP machine?

talking about corruption in health care, and need of reform??
Sure some lobbiest will fight tooth and nail to keep this corrupted system intact

what can be done by some sleep labs by under $500 is done by $14000
sure your doctor need a new test every 6 months !!!

[Uncle_Bob]

Initial Study billed at $1900 insurance paid $651
Titration billed at $2000 insurance paid $893 of which my co pay was $223.

I was happy with my study, a very nice place like a hotel room with private bath and TV with DVD player etc. I could watch a movie while getting wired up

http://www.scottsdalesleepcenter.com/

[lebowski8]

Wow, that's about 10x what I paid.
I have a high deductible AETNA plan -- so I paid essentially out of pocket. I had 2 overnight sleep studies (one no cpap, one with cpap) & 3 total consultations with my neurologist / sleep doctor.
The total for all of that was $1850.
I also paid upfront for my machine & masks at CPAP.com -- this saved me 40% vs. the suggested DME's "rental" baloney.

Sorry to hear you got ripped off.

Maybe you can try to negotiate lower payments?

[Jim Smith's girlfriend]

Today i called the Dr. office to speak with an office manager. She was not in, but did speak with the receptionist. I explained my story and asked if there was possibly a code mix up from DR.'s office to hospital for billing. I was informed they didn't have any thing to do with that and put me on hold to ask the Dr.'s billing clerk. When she got back to me she explained the sleep center does the billing for the hospital. She also agreed this was an absorbent amout to be billed and could not believe I wasn't informed prior to study. She apoligized for having to pass me on to someone else to ask Q's. But also told me to call her back if I could not get this resolved and she will take up the situation w/ the Dr. She gave me the # for the sleep study center.


I call the Sleep Center, the guy knows who I am immediatley. I explain AGAIN. He tells me the hosptal has a set fee. Any place can set any price, does not mean they will be paid that amount. My Insurance Co. allowed almost 4300. and thats what the hospital billed. I asked why I was not informed prior of study? He had no answer. He asked if I spoke to someone in billing to make up a payment plan or possible discount rate? I inform him for the 2nd time hospital points finger at Ins. and Ins. points finger at hospital and NO know one has offered me nada. So he tells me he is going to contact hospital billing himself.

So about 15-20 min later I get a call from hospital billing. I explain AGAIN. She asks if I know with whom I org. spoke with from billing the day before? Unfortunetly I don't, but from an 800# I called. She knows who I spoke to and was to take note. She understands my frustration and I appoligise if I souneded like I was coming at her side ways(explaining yourself 10x in 45 min. is frustating) She laughs and can just imagine. She explains as the gentleman did at the sleep center about the hospiatal billing. Hospitals will charge what they want, Ins. Co have fifty million policies, so even though I had same ins. Co. last year the policy is different. She tells me the genleman from the sleep center should have told me about the amount and asks me if I ever inquired. I tell her no because of my proir statements from other hospital. She then explains to me that they can set up payment at a reduced rate. 40 percent off and pay in 30 days. or 30 percent off w/ 30 percent down and 3 mos. payments after that. She is also going to send me an itemized bill for the study. Whith that said she also informs me that the other hospital were the first 2 studies were done is a for profit hospital and their hospital is not,so if someone comes into the hospital and has no ins. Its on the hospital. Thats why the charged the amount of 14000.00. WELL THANK GOD I WAS AT WORK IN A PUBLIC PLACE OR SHE MAY HAVE GOTTON AN EAR FULL FROM THAT COMMENT!


So now I'm going to the first hospital to get itemized bills from the first two studies. I am also going to print out info regarding some of your posts and take everything I have and get to the DR. office. AT $2500.00-$2800.00 to pay is still a little insane. Espically after other folks are paying a lot less( small Ins. Payment) or nothing at all due to not having Ins. and going to a non profit hospital.