Tag Archive | "Polysomnography"

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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Not Having Enough Dreams is a Major Problem

Too many people are feeling tired during the daytime.  Too many people are waking up in the middle of the night and having a hard time falling back to sleep.  Way too many people are snoring so loud that their bed partners will not under any circumstances sleep with them anymore.  This seems to be the problem that is all too familiar to millions of people these days.  When is it all going to stop.

The whole issue of having dreams is one which is difficult at best to understand and wrap our hands around.  There are just too many people who are waking up in the moring and drinking extra cups of coffee or drinking ten cans of coke or pepsi all day long just to stay awake.  This is not good.  This is most definitely not normal or natural.  This can most certainly be one major thing: living with a sleeping disorder.

Dreams happen during REM(Random Eye Movement) sleep.  This sleep stage happens in most people for about 20-35% of the night.  Although scientists do not understand it completely, it is a known fact that when patients eliminate or reduce their REM sleep either voluntarily or due to physical or mental reasons, the rest of their life is impacted negatively.

There have been several studies comleted by Dr. William Dement who is considered the “Father of Sleep Medicine” from Stanford University, and he has been able to conclude that a lack of REM sleep will negatively impact someone’s life.  By that he has been able to record more irritations, much more sleepiness during the daytime, among other things.

If you are feeling tired during the day each and everyday, it is time for you to get tested during a sleep study to find out if you also suffer from a sleeping disorder.

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