Does Insurance Cover Sleep Studies?

One of the biggest concerns when it comes to sleep studies is whether or not a person's insurance plan will cover the cost of a sleep study. And this is a perfectly reasonable concern because a lot of health services and procedures can be quite costly including sleep studies.

And while it's nearly impossible to write out exactly what one can expect from their insurance companies, we were able to come up with a few generalized tips and guidelines to follow when figuring out whether or not your sleep study will be covered by your insurance.


Sleep Studies Covered By Insurance

Does Insurance Cover Sleep Studies?

The short answer here is YES; sleep studies are covered by almost all insurances. However, some insurance plans have different rules regarding sleep studies than others. For instance, some insurance plans will require that you have a Home Sleep Test (HST) before they will cover an in-lab test (PSG). As HSTs are able to accurately diagnose 75% of patients with sleep apnea that has been properly screened by a physician, it often isn't necessary for them to order the more expensive (albeit more accurate) PSG study.


Steps-Cum-Process

Evolution In-Network

One of the things you really need to look out for when scheduling a sleep study with a clinic is to find out whether or not your insurance company is "in-network" with the clinic. When a clinic is in-network with your insurance company it means that the two entities have come to an agreed-upon discounted rate for services.

What this means for you is that if we are in-network with your insurance, your insurance will pay less for our services at a pre-established rate, and you will pay less of your own money as well. However, if the clinic you are scheduled for is out-of-network, they will either have to pay a higher rate, they will only agree to pay a certain amount leaving you paying more, or they can even deny paying, sticking you with the whole bill.


Deductible

Your deductible is an amount that you must pay before your insurance begins to pay for any services each year.


Co-insurance

Your coinsurance is your shared cost of a health care service. It's usually figured as a percentage of the total charge for the service. You start paying coinsurance after you've paid your plan's deductible.


Co-Pay

A copay is a fixed rate you pay for a health care service when you receive the service. Most copays are for filling prescriptions and rarely for services such as sleep studies, but your insurance may have it written that you have to pay a small upfront fee at the time of service. The amount can vary depending on the type of service.


Out-of-Pocket

Money in pocket, Out-of-pocket typically refers to the maximum amount you will pay of your own money for covered medical expenses in a given year.

Many insurance plans will begin with a deductible needing to be met, followed by a coinsurance percentage that you are responsible for up to a given amount. Once that amount is hit and you have paid your maximum out-of-pocket limit, your insurance will usually begin to cover 100% of the charges.


What if You Don't Have Insurance?

One of the options for patients without insurance plans is to check out medloanfinance.com. Medloan is a medical finance company that is willing to work with people of all credit backgrounds to help them get needed medical coverage. If you need help getting coverage, visit their website, and within one business day they can notify you of your coverage options.


Written by - Bhagyadeep Jena

Edited by - Gunika Manchanda