Cost of sleep study - Humana

[Renetrips]

Hi all,

Dh is scheduled for a sleep study in about 10 days based on a long history of chronic exhaustion, my hearing pauses in his breathing at night sometimes, then using a pulse oximeter at home that I got from Amazon that records overnight that showed a pattern consistent with sleep apnea.  

I'm relieved that there might be something that will help him feel better, but am ready to pull my hair out when it comes to finding out what this is going to cost us.  I will try not to rant about health insurance in this country!  LOL  

We have a high deductible plan with Humana through my employer. The test is covered, but what I can't find out from anyone at Humana or the sleep center, at least so far, is what the contracted amount is for the study.  The sleep center bills 2,700.00 for the in lab study and 700.00 for a home study.  I'm sure Humana allows less than that, which is what we will be responsible for, but I can't get answer on what that amount might be.  My latest mammogram, for example, was reimbursed at about 25% less than the amount billed.  

If anyone here has Humana (or probably any of the other major insurance plans - I assume they are similar in this regard) and know what the allowed amount was for a home study or an in lab study, can you give me a ballpark?  Dh is beginning to balk at the idea of 4,000.00, which is our deductible, and say things like "I've been tired for years, I can be tired longer".  If it may cost significantly less than the billed amount, that would helpful to know.  

Thanks!

[Renetrips]

I should be clear that I am aware that policies vary, so I am just looking for ballpark numbers.  I know our plan may not be the same, but I'm hoping I can get some kind of general idea, which would be more information than I have now!

[SarcasticDave94]

Certainly it won't be the first time I'm wrong, but I'd think your insurance company should be able to answer how much they allow for these sleep study sessions. Again, I'd think their answer should be "we cover this much ($X)".

FWIW if at all possible, get some sort of acceptable sleep study to satisfy a CPAP approval as pauses in breathing likely won't go away on its own. Sincere best wishes to you both on making successful progress. Good health is worth fighting for.

[Renetrips]

Thanks, Dave.  I would have thought the same thing, and said as much to all the different people at Humana I have spoken with.  I have pointed out to them that they clearly have the information somewhere, since it will be on my EOB once a claim is submitted, but I am getting nowhere.  

I really don't want him to bail on this study - he has spent years complaining about how tired he is, and how much he hates that he falls asleep pretty much as soon as he sits down in the evening.  The amateur home study we did for 4 nights showed each night he dipped down close to 70% at least once or twice, and below 88% a number of times, though the AHI showed up at around 6 - 9, which if I was reading correctly is mild apnea.  I don't know how accurate this thing was as far as numbers, but there was a clear pattern that looked very similar each night, and the family doctor took one look at it and said "it's diagnostic, but you'll need a sleep study for your insurance".

[Walla Walla]

Here's Humana's Corporate phone number. 1-800-486-2620 Call them and ask them about why you can't get an answer.

[SarcasticDave94]

Thanks to Walla Walla, you have a Corp number to try. Myself, I did sometimes have to call my insurance customer service a few times to get questions answered that the first person couldn't. Hope this helps.

[OpalRose]

The sleep center should have that information. They normally check on your coverage and what portion you would owe them way before the study is scheduled.

[SarcasticDave94]

The sleep center should have that information.  They normally check on your coverage and what portion you would owe them way before the study is scheduled.

Good point, don't know why I didn't think about that.

IMO someone at either the sleep center or insurance is slacking off. Seems like it'd be a frequently asked question to me. How much will you pay for procedure x? Uhh dunno...

[OpalRose]

Yep, it seems to me that when my husband or I had surgeries or other procedures done, we were told beforehand what our portion would be.  

Being that insurance coverage varies greatly, it would be next to impossible for us to give a ballpark figure.

[Renetrips]

Right?? I just spent 40 minutes on the phone with Humana Corporate to be told that after we meet our deductible they will pay 100%. I already know that. They can't/won't tell me what they will allow. I have called the sleep center several times and they tell me they don't know, either, which seems unlikely. They can tell me what they charge, but not what Humana pays, which hopefully is significantly less. At this point, the pre-authorization is still pending, so maybe after that they will give me information? I need a drink!