Categorized | Sleep Apnea

How Sleep Doctors Bill Health Insurance

Sleep Doctors Can Make Money in Many Different Ways

One of the most lucrative types of doctors out there these days are the sleep doctors of the world.  The main reason for this is that there are just so many ways to make money as a Sleep MD, and so many different ways to have health insurance companies cover the costs.  The world of sleep medicine is not one which most people have every heard of, or even understand, so within this investigative article, I will try to explain everything I know about the world of sleep medicine in the modern day society.

Sleep doctors are expected to deal with the 80 plus sleep disorders that exist.  That’s right, there are many different sleep disorders, but the reality is that they deal almost exclusively with two main ones.  Restless Leg Syndrome being a common sleep disorder along with Insomnia which we have all heard of.  Those two make up usually about 10% of the patients that sleep doctors see.  The overwhelming majority of patients a sleep doctor see though are patients who suffer from Obstructive Sleep Apnea or OSA.  This effects millions of people all over the United States and the rest of the world everyday and is often undiagnosed.

Let’s focus on how sleep doctors earn money and bill insurance and Medicare for their sleep apnea patients by looking at a list of billable medical services:

  1. Initial consultations and office visits with patients who are referred to them by primary care physicians
  2. Overnight in-lab sleep studies
  3. Interpreting the sleep study diagnostic results
  4. Follow up consultations to review the sleep results
  5. Ordering in lab overnight titration sleep studies for patients who were previously diagnosed with sleep apnea
  6. Interpreting the titration results
  7. Consultations to review the titration study results
  8. Prescribing and explaining therapy such as CPAP
  9. Quarterly follow up office consultations to review how the therapy is going and if the sleep apnea is getting better
  10. Annual titration studies to find out if anything has changed
  11. Providing the medical equipment such as CPAP’s and masks to the patients and then selling the CPAP supplies in the future

This list above is actually a typical process that a sleep apnea patient would need to go through with a sleep doctor who owns a sleep lab as mostly is the case.  Every single office visit and consultation and especially the sleep studies are all billed to the health insurance company, and many times the amounts will exceed $10,000 or more when everything is all said and done.  For patients who have only a high deductible insurance plan, this is often not a doable options for them, and they will usually cancel the entire appointment because they will not be able to afford it at a later date.  Much of the un-needed expenses that the patient and insurance company pay for are associated with the overnight sleep study and the excessive office visits.  The typical office visit for a PPO insurance patient to meet with a sleep doctor ranges between $150-$230 per 30 minute visit.

3 Responses to “How Sleep Doctors Bill Health Insurance”

  1. bill says:

    I’m not a sleep doctor but know the filed well. This is ridiculous and misleading information. Shame on you.

  2. Richard says:

    Please do your homework on the reliability of a home sleep study. You are right, technology is getting better and better, but you are writing an article about an event that has yet to happen. This is not to say that a home sleep study will ever replace a sleep attended study in any way shape or form.

  3. Frank says:

    Thanks very much for your comments. I think it is safe to say that a sensitivity and specificity of 87% and 89% respectively for a home testing device such as the WatchPAT made by the company Itamar, the reliability when compared to PSG testing is incredible. And when the founder of the Board of Sleep Physicians Dr. William Dement (who invented the PSG sleep test) agrees, well… not much more needs to be said.


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