Health Insurance Coverage for Sleep Apnea

Treatment for Obstructive Sleep Apnea, including oral appliance therapy, is generally covered by health insurance. This includes PPOs (Preferred Provider Organizations), HMOs (Health Maintenance Organizations), POSs (Point of Service Plans), HSAs (Health Savings Plans), HDHPs (High Deductible Health Plans), and Medicare Part B. Coverage amounts vary greatly by individual insurers and insured groups. Dr. Perkins and his staff are happy to help patients get the maximum coverage possible for sleep apnea treatment. We will also file your medical insurance claims as a service to you.

The most prominent variables across insurance plans that policyholders need to understand are:

  • Does the policy require an in-home sleep study before it will pay for a clinic or in-lab sleep study?
  • Does the policy require a physician’s referral before a study is performed?
  • Does a sleep study need prior insurance approval before it is done?
  • Does the plan only pay in-network providers for sleep apnea studies and supplies?
  • Does the plan require an annual deductible amount be paid before it will pay for services?
  • Does the plan require co-insurance payments for studies and supplies?
  • Does the plan require co-payments for sleep apnea studies and supplies?
  • Does the policyholder have an annual out-of-pocket expense limit that must be satisfied before the plan pays for services?

Does Your Insurance Cover Sleep Apnea Testing?

Policyholders should never take for granted that their policy plans cover all physician recommended medical services. If a patient is referred to a clinic or laboratory for a sleep apnea study, the patient needs to confirm with either their insurance company or the sleep study group that (a) the provider of the sleep apnea study is an in-network provider approved by the insurance company, and (b) what amount, if any, the policyholder will be responsible to pay. The majority of clinics and laboratories work with the insurance companies, on behalf of the referred patients, to assemble all of the required medical reports and to fill out all of the documentation necessary for each step of the study.

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