Tag Archive | "Obstructive 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.

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Snoring Surgery

Obstructive sleep apnea

Image via Wikipedia

What Is Snoring Surgery?

There are several different forms of treatment for Obstructive Sleep Apnea.  Continuous Positive Airway Pressure(CPAP) is by far the most common and most effective treatment.  That is something that is not disputed by nearly anyone in the medical community.
There is also a new treatment that is gaining momentum and it is known as a minimally invasive procedure.  Please notice how the term surgery is not part of that description.  This is usually performed however by an Ear Nose and Throat(ENT) doctor.  Most of the time, this type of treatment is something that takes place in a medical office and patients always are able to walk out after under their own power.

What happens during this type of procedure is there are lasers and radio frequencies which can help to reduce tissue within a persons airway.  This reduction in tissue opens up the airway so snoring can be avoided during the night.  Sometimes, patients who receive this type of treatment will need to have a follow up procedure to remove some more parts of the airway, but again, this is a very pain-free type of treatment.

If anybody is interested in this simple procedure to get rid of snoring without having to wear a CPAP machine, you should first consult with your primary care doctor.  Your medical provider might be able to refer you to someone who is an expert in this type of treatment.  Be very wary of a general surgeon who claims to be an expert in this type of thing.  You are dealing with your airway after all and you definitely don’t want someone to be working on you who is not qualified.

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