Question:
Are sleep studies not covered by Ins.?

From all the reading I've done, it appears that testing for Sleep Apnea is not covered by insurance. Is this true only if it comes back negative? I'm trying to get this done and would like to be prepared. I know insurance companies vary on what they cover, but in general, do they usually not cover this?    — Kathy S. (posted on September 26, 2002)

September 26, 2002
Kathy, It is best to call your insurance company. My insurance company covers sleep studies if it is medically necessary. Mine was covered. Best of luck...Dana
   — Dana R.

September 26, 2002
If a sleep study is done just for the sake of doing one without you having any symptoms then most likely they will not cover it. This is not a routine test. If you are having restless sleep, loud snoring, awaking with headaches, not able to stay awake during the day, or if your sleep partner is aware of your breathing cessation during the night, if you have a chronic cough, or a host of other symptoms, then it becomes a medical necessity and it should be covered. Some policies specify that the sleep study be completed in one night. Then you will sleep half way through the night on your own. Then they will wake you after four hours and you will be fitted with a CPAP to monitor your sleep for the remaining night. Call your insurance company.
   — Sue A.

September 26, 2002
My sleep study was covered by my insurance. My PCP put in the request for one and it wasn't a problem at all.
   — Sarah K.

September 26, 2002
Most sleep labs won't even schedule you for a test unless you have been pre-approved by your insurance. Normally all it takes is your PCP putting in a request for the test. In some cases you have to see a sleep specialist before the study is done. That is covered as well as the study. Whether the study is negative or not has no bearing as far insurance coverage is concerned.
   — LLinderman

September 26, 2002
My sleep study was covered. I just had the sleep health center fax a letter to my former Pcp and she filled it out and faxed it back. I was then able to have the sleep study scheduled. If your PCp or another health professional backs you then it should be covered.
   — Teekay80

September 27, 2002
Kathy, my insurance company covered my sleep study even though I turned out to not have sleep apnea. I had a co-pay I had to cover, but it wasn't that terribly much considering the total cost of the test.
   — Hackett

September 27, 2002
I AM A SLEEP TECH REALLY IT DEPENDS ON YOUR INS (FOR EXAMPLE I AM FROM AL. MOST PEOPLE AROUND HERE HAVE BLUE CROSS BLUE SHIELD AL. THIS INS WILL PAY IF YOUR RDI (RESPIRATROY DISTURBANCE INDEX) IS 5 OR GREATER. BUT REALLY WHAT YOU NEED TO DO IS CALL YOUR 800 NUMBER ON THE BACK OF YOUR INS CARD FOR COVERAGE QUESTIONS BUT IT VARIES GREATLY FROM COMPANY TO COMPANY. ALSO OF GREAT IMPORTANCE IS THE FACILITY WHERE YOU ARE HAVING YOUR STUDY DONE IS ACCREDITED OR NOT. WE ARE A ACCREDITED SLEEP LAB THEREFORE MOST INSURANCES WILL PAY FOR THE STUDY. IF THE SLEEP LAB YOU USE IS NOT ACCREDITED YOUR INSURANCE MAY NOT PAY FOR YOU TO HAVE IT DONE THERE
   — DENICE C.