Cost is one of the biggest reasons people put off a sleep study. The good news is that most health insurance plans, including Medicare and many commercial plans, cover sleep testing when it’s medically necessary. Here’s how coverage usually works, so you know what to expect. Your exact coverage depends on your plan, so always confirm the details with your insurer or our office.
When is a sleep study “medically necessary”?
Insurers generally cover a sleep study when there are symptoms or risk factors that point to a sleep disorder, such as:
- Loud snoring with pauses in breathing or gasping
- Excessive daytime sleepiness
- Suspected sleep apnea, narcolepsy or other sleep disorders
- Conditions linked to sleep apnea, like hard-to-control high blood pressure
Your doctor’s notes about your symptoms are an important part of showing medical necessity.
Do I need a referral?
Many plans require a referral or an order from your doctor. Even when a referral isn’t required, your sleep center will usually work with your primary doctor so everyone is on the same page.
What is prior authorization?
Some plans require approval before the study takes place. This is called prior authorization. A good sleep center handles this paperwork for you and won’t schedule your study until it’s approved.
Home test or in-lab study?
Some insurers ask that patients with suspected uncomplicated sleep apnea try a home sleep test first. An in-lab sleep study is often covered when a home test isn’t appropriate, when other sleep disorders are suspected or when a home test is inconclusive. Our article on home sleep tests vs. in-lab studies explains the difference.
What will I pay out of pocket?
Your share depends on your deductible, copay and coinsurance. Before your study, our team verifies your benefits and lets you know what to expect, so there are no surprises.
Questions to ask your insurer
- Is a sleep study covered under my plan?
- Do I need a referral or prior authorization?
- Is International Institute of Sleep in my network?
- What is my deductible, and how much of it have I met?
- Is treatment, such as a CPAP machine and supplies, covered if I’m diagnosed?
We’ll help you sort it out
International Institute of Sleep works with many major insurance plans. When you call to book, we’ll check your coverage and walk you through your options.
Book a sleep study in Deerfield Beach
Ready to get answers and better sleep? Call 1-800-481-3870 or request an appointment online. International Institute of Sleep is headquartered at 2151 W. Hillsboro Blvd., Suite 100, Deerfield Beach, FL 33442, and serves patients throughout Broward and Palm Beach counties.
This article is for general information and is not medical advice. Talk to your healthcare provider about your symptoms, and don’t stop or change a prescribed treatment without their guidance.
