[Diagnosis] cost of my sleep study

[withtao]

I had a sleep study done a month ago.  I have insurance, Medicare Advantage.  Got the bill today:

Billed $7,460.00
Insurance Covered -$7,450.00
You Paid -$10.00

How can anyone afford this without insurance?

[Sleeprider]

What is really crazy is that Medicare insists on a sleep test to be dispensed a covered CPAP machine which costs a fraction of the test cost. Without insurance you could use an inexpensive home sleep test that includes the analysis and prescription from many alternative providers, or just ask your doctor for a script. People can buy new or used equipment through a discounted channel. The cost of your sleep study amounts to nothing short of theft.

[withtao]

... The cost of your sleep study amounts to nothing short of theft.

Yep.  What's really messed up is that my PCP ordered a new AS11 through an approved DME vendor (took 7 months).  The vendor didn't require a new sleep study, but my PCP wanted one in case the DME required it and it had been over 7 years since my last study.  The sleep study was at a facility operated by my HMO.  The sleep study prescribed 8-15 with EPR of 3, my old AS10 was set with a fixed pressure of 10.  When I asked for help in setting up the new machine, my PCP told me that the AS11 would come correctly configured and I was not to touch it. Of course it wasn't configured because the DME wasn't provided the study results by the PCP.  So, I used the AS11 on the fixed setting of 10 for a week and then went in and set it to 8-15 EPR 3 as prescribed.  My results using APAP were better than the fixed setting and I'm getting longer periods before arousals. But, what do I know ;-)

Thanks.

[clownbell]

OP asks "what do I know." I submit that OP knows more than he/she gives him/herself credit for. 1) knowing that something was wrong with the machine not being set up. 2) starting with prior machine settings 3) trying the new settings 4) knowing how to change the settings. I think it is likely that too many users blindly trust their sleep doc or the DME. OP advocated for self, and that is a good thing.

DME, on the other hand, was apparently too lazy to ask the prescriber what the settings should be. That's pretty unprofessional IMO.

[Sleeprider]

Withtao, I am facing a similar dilemma. My last sleep study was in 2008, which found very severe OSA. My current machine is over 6-years old and well north of 20K hours of use, so my doctor wrote a script for a replacement machine. The DME called and said I would need a new test. I responded I have the original test that should be valid, and please submit the claim to Medicare and leave it to them to deny. Instead "Tracy" suspended my account without telling me, and I have had no re-supply since March. When I called last month that it seemed to have been a long time since my last supply, I learned my account is suspended and nothing I can to to reinstate. I have been on Medicare for nearly 4-years and this is what I get. The idea of a sleep study is unimaginably painful without PAP.

I will try to go around this supplier and see if another will resume the coverage, but I suspect a test will be unavoidable and a complete waste of money.

[withtao]

The DME I was hooked up with while with a previous HMO and is still my DME and has been terrible to work with.  I was fortunate that my current Medicare HMO wanted a new study.  Ironically, as I mentioned, the DME didn't demand a new study.  They just used the settings from my first study from back in 2015. The issue is a terribly broken profit-based health care system. Don't get my started. ;-)

[OpalRose]

I've been through the same nonsense. When my doctor sent a new script to the DME for a BiPap, the DME told me that I'll need a new sleep study to see if I qualify for a BiPap. This was during the height of Covid. I refused the sleep study and suggested that they honor the doctors prescription order.

They rudely told me that it doesn't matter what the doctor's script says, and that insurance will require a sleep study. They refused to submit the request to insurance.

I eventually bought my own BiPap. Oddly, the DME still sends supplies and submits to insurance.

[Big Guy]

I had a two night local in-lab sleep study back in mid August of 2018. I was told that it was expensive, but I never saw a bill for it. Medicare and BC/BS supplemental paid 100% of it.

[withtao]

After waiting for 5 months, my DME canceled the request to my Medicare provider for the CPAP machine and notified my PCP that they had to speak with me and let the DME know that they did!  So I had a tele-health session with my PCP and she submitted the results of that interview to the DME and they re-requested the CPAP prescription to the Medicare provider.  What the heck did that accomplish?  No study just a conversation on our smart phones.  Go figure.  What a messed up system.

[Nightynite]

I found this site when I suspected I had sleep apnea. I learn so much here and that knowledge lead me just to ask my pcp for a home sleep study. When I received the results I knew exactly what apap machine I needed. This site taught me about sleepyhead/Oscar and the rest is history or should I say job well done Apnea Board. Cost through Medicare and PCP Probably under $300