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Will Insurance Cover My Sleep Study?

Make sure you're prepared before your sleep study by knowing ahead of time what your policy covers and what portion is your responsibility (photo credit: BigStockPhoto.com)

Health insurance today can be frustrating or beneficial, spending on how well you know your plan.  (photo credit: BigStockPhoto.com)

Advances in sleep medicine mean it is easier than ever to find the answer to the question “Why Can’t I Sleep?”   Sleep centers and better sleep testing make it possible to find out what is happening during sleep and to get sleep disorders like sleep apnea and narcolepsy diagnosed.  For those who have struggled for years with all the problems chronic sleep deprivation can cause without understanding why, these advances can be life changing.

At the same time, research in recent years has demonstrated unequivocally that sleep is one of the cornerstones to good health.    When you don’t get the sleep you need, the consequences to your health can be catastrophic and long lasting.  Sleep deprivation has been linked to increased risks for everything from diabetes to heart disease to obesity to cancer.   And the best way to manage problems with sleep is to get them diagnosed so that they can be properly treated.

Meanwhile, with all of the recent healthcare reform, many new changes have been implemented for both individuals and businesses alike. Many people change insurance plans to find the most affordable one for their out of pocket expenses each month. At the same time, as insurance companies are also adjusting coverages in the plans they offer, the many different levels of coverage within an individual’s policy may be different than they anticipate.

Given all this, it is easy to make some incorrect assumptions about how your health insurance company covers the sleep testing you need in order to have any sleep disorders or problems diagnosed.  For many people, assuming that everything to do with your sleep test and diagnosis will be covered by your insurance can end up causing some sleepless nights.

The bottomline when it comes to sleep testing and treatment and health insurance coverage is that it depends.

There are many different health insurance companies that offer a variety of different plans.  Some companies will cover more of the services involved in sleep testing than others.  You may need to get a pre-authorization or referral for your test to be covered or there may be additional co-payments or co-insurance that will have to come out of your pocket.

Because of this, there are no hard and fast rules about what is covered and what is not.  The only way to know for sure is to contact your health insurance provider prior to your testing date to find out what they will cover, what they won’t cover, and what you need to do to get the coverage they offer. 

To help, here is a list of questions that you can use when talking to your insurance company so that you don’t have any unpleasant surprises after your sleep testing. 

  1. What kind of insurance coverage do I have for sleep testing?
  2. Do I need to go to a specific sleep center in order for my testing to be covered?
  3. What percentage of the charges for a sleep study will be covered?
  4. Do I have any deductible that applies to sleep testing?
  5. Do I have a co-pay or co-insurance that I will need to pay?
  6. Are there any sleep testing related charges or services that are specifically not covered?
  7. Do I need a pre-authorization before my sleep test?
  8. Do I need a referral from my primary care physician?
Client Reviews

"Great staff, they make you feel so at home. Every medical facility should be this nice. Felt like a nice hotel. Someone has great taste in decorating. Thanks for making us feel at home."

Steve N.

San Diego, CA

"I was especially impressed with Andrew the Respiratory Therapist who reviewed my study with me and answered my questions. Andrew thoroughly explained everything about the Cpap machine-from start to finish. I never felt rushed and was assured I could contact him with any additional questions or needs. Andrew told me he would follow up with a call in a week and he did. I believe this center performed the study appropriately and the added benefit of having Andrew teach me about the machine and what to expect was a bonus."

Candace M.

Scottsdale, AZ

"I recommend them highly!! I took my 2 year old daughter for a sleep study and was very impressed. Our sleep technician was amazing with her, very patient and kind. The DVD we brought to watch while getting her hooked up got stuck in the TV and they vowed to return it. We got a call the next day checking on our daughter and saying how sweet she was, they mentioned the DVD. Several days later, we received the DVD plus a new copy of the Lion King with a nice note. They are very good at what they do and if they can make a 2 year old feel at ease, they can probably do the same with anyone!!"

Anthea S.

Tempe, AZ