When Should You Avoid Using Healthcare Insurance for A Sleep Study

Joseph Krainin, M.D.3 comments

Insurance Versus Private Sleep Apnea Testing Companies:

Did you know that following the traditional route of using your health insurance for your sleep apnea test could end up causing you major headaches and potentially costing you thousands of dollars? Read on to avoid potentially costly pitfalls.  

Sleep apnea is an extraordinarily common medical problem. Research suggests that as many as 20-40% of adult Americans have the disorder and 80% of those are as-yet undiagnosed. In this article, I discuss potential advantages of having sleep apnea testing without insurance. First, you need to know some background about the history of health care in the United States.

Pre-Existing Conditions: Then and Now

In the past, there was a great deal of anxiety about having a medical condition documented in your medical record due to the ramifications of having a "pre-existing condition." The concern was that, with pre-existing conditions, the insurance company might increase your health care premium or deny you coverage altogether. The insurance companies would be incentivized to do this because your pre-existing condition might cost the insurer too much money to allow them to make any margin on you. Certainly, a sleep apnea test and CPAP equipment could be quite expensive for an insurance company to pay for.

ACA to the Rescue

 One of the most popular parts of "Obamacare" was putting this issue to rest. The Affordable Care Act (ACA) forbids insurers from holding pre-existing conditions, such as sleep apnea, against you when determining your eligibility for coverage and your premiums. Therefore, the fear and loathing about pre-existing conditions is gone and everyone should take advantage of their health insurance benefits to pay for their sleep apnea study, right? Let's unpack that assumption and learn about some reasons why you might want to choose a company that can offer you a "no insurance sleep apnea test."

In Certain Circumstances, Having Sleep Apnea as a Pre-Existing Condition Can Still Cost You

There are a few areas where you may still need to be aware of having pre-existing conditions documented in your chart. Remember, if you go through your insurance, any test results and diagnoses will become part of your permanent record, so don't forget to think ahead.

Life Insurance

Let's say you have a family; a wife or husband and a few children. If you're the major breadwinner in the family, getting life insurance is a smart investment.  With life insurance, you can sleep well at night knowing that, should something happen to you, your family will be financially taken care of. You need to know that life insurance is different from health insurance. Life insurance companies can still take your medical conditions into account when determining your premium. Life insurance actuaries know that sleep apnea increases your risk for sudden death, heart attack, stroke, and cardiac arrhythmias. It's only natural that your premiums will bump up due to your documented sleep apnea.  Since you'll likely be paying this premium over upwards of 20 years, there may be a significant cumulative hit to your finances.

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Job-Related Regulation

Truck driving is the most common job in the United States. Sleep apnea has become a major issue for drivers. Drivers are increasingly under more restrictive demands to be screened and tested for sleep apnea, due to the strong association between sleep apnea and motor vehicle accidents. This same level of scrutiny is starting to apply to pilots, boat captains, train engineers, and other transportation-related professionals. A diagnosis of sleep apnea can be a game-changer if you work in one of these fields, as you will be forced to use a CPAP machine and demonstrate sufficient "compliance" with the treatment. If you do not, your medical card will not be renewed by your occupational health physician. This, of course, will prevent you from working and take money right out of your pocket.

Many drivers like the idea of seeking a sleep apnea test outside of their insurance, even preemptively pursuing testing before they are required to do so by their DOT (occupational health) physician. This way, they maintain control of the situation. Drivers need to know that if they get tested through their health care insurance, that test result will be added to their permanent medical record. Some drivers want to know whether they have sleep apnea to see if they can lose weight or employ other lifestyle interventions to get rid of the sleep apnea before having to report to their DOT physician.

The bottom line is, if you'd like to find out if you have sleep apnea but want to keep your sleep study report completely private, you'll need to avoid using your health insurance company.

Financial Considerations

Many insurers allow their physicians to determine what type of sleep testing is needed. When a sleep apnea doctor owns the sleep lab and has a choice, they typically choose an in-lab sleep apnea study (polysomnogram) over a home sleep study. The justification is that the sleep lab-based study provides more and better data but one also has to consider the financial incentive that the sleep apnea doctor has, as an in-lab sleep study pay much more than home sleep study. However, you, the patient, might get hit with a significant bill for such a sleep apnea test. Co-pays for in-lab studies tend to be much higher than a home sleep test. If your doctor is pushing you to do an in-lab sleep study but you're looking at a major financial hit, you might consider taking matters into your own hands and getting an at-home sleep study through a private sleep diagnostics company, which offers low-cost home sleep apnea testing. 

Even if an in-home sleep apnea study is an option for you, it may be in your best financial interest to go through one of the private sleep apnea test companies. If you have a high-deductible plan, which is becoming increasingly common, you may find significant savings in going outside of your insurance for your sleep study and using a private sleep apnea test company. Be a savvy consumer and shop around before you commit to the provider that is contracted through your insurer.  

Lifestyle Factors

Time is of the Essence

I'm fond of saying that everyone is on his or her own journey to addressing sleep apnea. The possibility of being diagnosed with a medical disorder for the first time is unsettling to a lot of otherwise healthy people who are dealing with sleep breathing issues. Also, the potential for having to wear a mask connected to a machine while sleeping can be quite off-putting to people. Many of those who suffer from sleep apnea have done so for years before they build up the motivation to pursue testing. My sleep doctor colleagues and I know that, once you have influenced the patient to overcome his or her psychological barriers and pursue testing, you have to move quickly to prevent inertia from setting in again. Unfortunately, when going through insurance, it can often take weeks or months to get in for a sleep study with a contracted provider. This creates a huge paradox: how can we as doctors continue to tell people how dangerous sleep apnea is and, when they're finally motivated to get tested, tell them that they're going to have to wait two months to get in for a study? To tell patients, "Sleep apnea is a potentially life-threatening problem," and then, "Hurry up and wait," in the same breath is an obvious contradiction. Private companies that provide sleep apnea solutions are usually much more efficient than those that are affiliated with insurers and are typically able to get the testing done rapidly. There are simply fewer hoops to jump through and red tape to get caught up in - you, the patient, get sleep apnea solutions when you need them.

How does the Idea of Spending a Night in a Sleep Lab Sit with You?

As I mentioned above, sleep doctors are generally incentivized to have you do an in-lab study as opposed to an at-home sleep apnea test. Besides the cost implications, there are also important lifestyle considerations, should an in-lab study be imposed on you by your sleep apnea doctor or insurance company. Do you think you'll be able to sleep normally in a foreign environment? Do you have young children, pets, elderly parents or disabled family members that, logistically, aren't safe to be left alone for a night? Do you want electrodes and paste applied to your scalp, ruining your new hairstyle? These are just some of the questions that patients often ask themselves when facing the prospect of an in-lab study. Sleep center-based studies can be a huge inconvenience and hassle, not to mention an unpleasant experience, that many people would like to avoid. If you fall into this camp, finding a quality, affordable private sleep study company just might be worth the investment. 

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sleep apnea test home sleep study Joseph Krainin Joseph Krainin, M.D., FAASM is the founder of Singular Sleep, the world's first online sleep center.  He is a Fellow of the American Academy of Sleep Medicine and board-certified in both sleep  medicine and neurology. He has been practicing medicine for over 10 years.

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Laura Burbie
Laura Burbie
I just called a sleep study lab that is ok through my insurance…it is $5500 for an in lab test and $1100 for an at home test!!! I have a $7900 deductible on my insurance, so I would have to pay for the entire cost! Which I cant even begin to afford! 🥺
Thomas Washburn
Thomas Washburn
I need a sleep study done as I stop breathing during the night so I’ve been told. I have no insurance and very little money. I snore loudly as well
Sonia milian
Sonia milian
I think I have apnea my insurance not cover

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