IF YOU HAVE INSURANCE COVERAGE YOU WISH TO USE -
APPLY THE COST OF YOUR SLEEP STUDY AND/OR EQUIPMENT TO YOUR DEDUCTIBLE;
YOU WILL BE SEEKING REIMBURSEMENT FOR THE COST OF THE STUDY AND/OR EQUIPMENT BECAUSE YOU HAVE NO DEDUCTIBLE OR HAVE MET IT FOR THIS YEAR:
YOU WILL NEED TO CONTACT YOUR INSURANCE COMPANY PRIOR
TO TESTING OR RECEIVING YOUR EQUIPMENT TO DETERMINE WHETHER PRE-AUTHORIZATION IS REQUIRED. YOU CAN CALL YOUR INSURANCE COMPANY AT THE PHONE NUMBER LISTED ON YOUR IDENTIFICATION CARD FOR "MEMBERS" OR FOR "PREAUTHORIZATION". THEY ALONE WILL BE ABLE TO ANSWER THAT QUESTION.
HOW INSURANCE WORKS
Anyone who has insurance realizes that it can be very confusing on what it does and does not pay. All insurance, whether private or government (such as Medicare) generally has a deductible that must be met each year. Also, there is generally a co-pay on most items.
When there is a deductible, it must be met BEFORE the insurance will pay on most diagnostic procedures (like a sleep study) or for durable medical equipment (like a CPAP or oxygen concentrator). The small fee you pay for an office visit to your doctor does not normally apply to your annual deductible. Every insurance company has many different plans that it offers so anytime you are unsure of what benefits your insurance provides, check the policy you’ve received from your carrier or visit with your human resources department to find out.
FOR EXAMPLE: If you have a $1,500.00 annual deductible, that amount must be paid by you to a provider before your insurance company will start paying their part (whether it is 80/20, 90/10 or whatever). If you want to use your insurance for a sleep study that costs $2,000.00 but have not met your deductible, you will be required to pay up-front the amount of the deductible. So, if your sleep study is more than $1,500.00, you will pay that amount to the sleep lab first. The full amount of the study will be billed to your insurance carrier, but only the $500.00 difference between the $1,500.00 deductible and the $2,000.00 cost will be eligible for coverage. If you have a co-pay (on an 80/20 plan for example), you will still be responsible for an additional $100.00 of the $500.00 remaining between the $1,500.00 you’ve paid up-front and the cost of the study. So, the study would end up costing you $1,600.00 out of your own pocket, even though you have insurance.
Also, some insurance policies have a separate deductible for durable medical equipment (DME). If you need a CPAP to treat your obstructive sleep apnea, and you have a separate deductible, you will have to pay that first also. If the deductible has been met, there may also be separate co-pay for the equipment. Please check your policy or call your insurance carrier.
Our company does not take insurance assignment. That is why our services and equipment are so inexpensive. That does not mean that our services/equipment are not covered by your insurance. It simply means that we are paid up front by you (just like the other sleep labs), but we charge much less. The amount of your sleep study and equipment can be submitted to your insurance carrier. If you have met your deductible, your insurance carrier will reimburse you directly for the sleep study and/or equipment. We will provide you with an appropriate receipt so that you can submit this cost to your insurance carrier following the completion of your sleep study and/or set-up of your equipment.