Welcome to our FAQ page dedicated to addressing common questions about medical insurance coverage for home sleep testing. Here, you'll find helpful information on how insurance policies typically handle sleep studies conducted at home. Whether you're new to home sleep testing or seeking answers to insurance concerns, we're here to guide you through the essential details.
Does Sleep Doctor accept private insurance for Home Sleep Tests?
Yes, we currently offer the Home Sleep Study with two payment options:
1) A cash pay rate of $189.00. Sleep Doctor accepts all credit cards, as well as HSA or FSA funds.
2) Coverage through insurance*
To use insurance for the Home Sleep Study, click here to check your coverage and fill out your new patient information form.
* Insurance coverage may vary. Not all plans cover the Home Sleep Study, and pre-authorization may be required.
* Home Sleep Studies are only available for U.S. residents 18 years of age and older.
Upon receiving your insurance information, Sleep Doctor will verify your coverage and provide you with the details and out of pocket cost via email within 3 business days.
Please note: If you’re planning to use insurance for CPAP or other sleep apnea treatment in the future, choose to pay with insurance now. Patients who start with a cash-pay sleep study and later use insurance for treatment often need to complete a new insurance-approved sleep study.
What happens after my insurance benefits are verified?
Once we've verified your insurance benefits and determined your estimated coverage, we'll email you a summary of your expected costs for each step of the process.
Your sleep study journey includes three separate services:
1. Pre-test consultation: After benefits verification, you'll receive an email with a link to schedule your pre-test consultation. Payment for this visit is due before your appointment. You’ll meet with a licensed provider to discuss your symptoms, sleep concerns, and determine whether a home sleep study is appropriate for you.
2. Home Sleep Study: If it’s determined that a Home Sleep Study is the best next step for you, we’ll ship your device to your home and you’ll complete your sleep test from the comfort of your own bed. Payment for the sleep study is due before the device is shipped.
3. Results review consultation: Once you’ve completed the test, your sleep study data will be sent securely to your provider and we’ll email you a link to schedule your results review consultation. You’ll meet with them to review your results, discuss your diagnosis (if any), and talk through recommended next steps. Payment for this visit is due before your appointment.
Why are there separate charges?
Your insurance may apply different copays, coinsurance, or deductibles to each part of your care:
- Your pre-test consultation
- Your home sleep study
- Your results review consultation
To make the process easier, you'll typically make two payments. The exact amount you owe depends on your insurance plan and benefits.
- One before your pre-test consultation, which includes any pre-test consultation copay plus your home sleep study device cost (copay or coinsurance)
- One before your results review consultation, which includes any post-test consultation copay
I changed my mind about the Home Sleep Study. Can I get a refund?
If you decide not to move forward before your pre-test consultation takes place, contact our team to discuss your refund options.
Because the consultation is a clinical service provided by a licensed healthcare professional, refunds are not available once the consultation has been completed and payment has been processed.
What are my out of pocket costs?
Out of pocket costs for Home Sleep Studies vary depending on your insurance plan. While some plans cover the full cost, you may still be responsible for a copay, deductible, or coinsurance. We will verify your insurance and provide you with your actual costs, then you can decide if it is more cost effective for you to use your insurance or to pay cash.
Terminology:
Copay: A copay is a fixed amount of money you pay for a health care service, like a doctor’s visit, every time you go. For example, you might pay $20 when you see the doctor, and your insurance covers the rest.
Deductible: A deductible is the amount of money you have to pay for health care services before your insurance starts to help pay. If your deductible is $500, you have to pay the first $500 of your medical bills, and then your insurance will start paying for the rest.
Coinsurance: Coinsurance is the percentage of the cost of a medical service that you have to pay after you’ve met your deductible. For example, if you have 20% coinsurance, you pay 20% of the cost, and your insurance pays the other 80%.
Why is my copay more expensive than paying cash for the Home Sleep Study?
Sleep Doctor doesn’t set the prices that insurance providers require. Occasionally, the cost set by your insurance provider may be higher than the price of purchasing the Home Sleep Study directly through us without using insurance. Additionally, insurance often requires separate billing for your pre-test consultation, the testing unit, and the post-test consultation. When you choose to pay cash, all of these costs are bundled.
What is a prior authorization (pre-authorization)?
Some insurance plans require prior authorization before a Home Sleep Study can be covered. If authorization is needed, we'll begin the process after your pre-test consultation. Most approvals are completed within 5-7 business days, though some may take up to two weeks.
In some cases, an insurance plan may deny coverage because the Home Sleep Study is considered out of network. If this happens, we'll let you know and discuss your available options.
Is there a time limit to complete the insurance process?
Yes. To ensure your insurance coverage remains accurate, the entire process must be completed within 30 days of your insurance benefits being verified.
This includes:
* Any required pre-test copay
* Your pre-test consultation
* Completing your home sleep study
* Any required post-test copay
* Your results review consultation
You can track your timeline using the date your insurance benefits were confirmed and the complete test by date, which is the deadline to complete the process.
If the process is not completed within 30 days, we'll need to re-verify your insurance benefits before moving forward. Because insurance coverage and eligibility can change, re-verification may result in updated coverage information or out-of-pocket costs.
If a Home Sleep Study is out of network with my insurance, can Sleep Doctor provide me with an invoice to submit to my insurance company?
Yes, we can send you an invoice with billing codes to help you request reimbursement from your insurance provider. The date of service on the insurance claim form is typically determined by the date the product is delivered to the patient. Check with your insurance provider for guidelines on how they handle claims for shipped products.