Tag Archive | "PPO"

What Happens During a Sleep Study



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Here is the complete process from beginning to end for a patient when a doctor refers for a sleep study:

  1. Referral is sent from your doctor’s office to a sleep lab
  2. The sleep lab then obtains the authorization from the insurance company to bill your insurance for the study
  3. The sleep lab will call you to schedule a time to come in for a consulatation
  4. After the initial consultation with the sleep doctor, they will schedule you to come back for the full overnight sleep study
  5. You go back for the actual study and sleep in a bed in a room, with an overnight lab technician watching you
  6. They connect you to 12 or more nodes on different points on your body to monitor many different “channels”
  7. If you show signs of having a sleeping disorder called sleep apnea, they will wake you up halfway through the night
  8. At this point, they will give you CPAP equipment to test if that helps your sleep apneas
  9. In the morning, you are able to go home
  10. Next, the sleep doctor comes into work, and reads the report that was recorded from your sleep and interprets the data
  11. The sleep study results are then sent back to your primary care physician

I know this sounds like an awfully long and drawn out experience, AND IT IS.  But it relatively inexpensive, only about $3,000-4,000 usually, sometimes as high as $7,000 or maybe more at places like big University Hospital Sleep Labs or large medical foundations polysomnography tests, but that is only because they want to bill your insurance as much as possible to increase their revenues.  Especially watch out if you have a PPO plan, in that case the sleep labs are likely to bill you for as many office visits as they can, and they may want you to actually spend two nights at the lab.  One night for the initial test, and the second one for using the CPAP therapy equipment.  I know this all sounds much like some type of medical insurance scam, and unfortunately it has somewhat turned into that for the sleep medicine world, and the sleep doctors in particular who own sleep labs themselves.  But after reading this, please know that you are at least warned of what is going on out there.  Best of luck and sweet dreams.

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Where to Get a Sleep Apnea Test



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If you have just finished a doctor’s visit and the doctor tells you that you might have sleep apnea.

You should get a sleep apnea test done.

A sleep apnea test sometimes is called a sleep study, it just depends on what your local doctors use.  But this is a test which is going to monitor your sleep to find out if in fact you have sleep apnea or OSA as its also called.  The OSA stands for Obstructive Sleep Apnea.

What is a Sleep Study:

A sleep study is where you either spend the night at a sleep lab and get connected to twelve or more nodes, and they monitor your oxygen, pulse, breathing, air flow, body movement, and your brain waves, or you can actually also have a sleep study done in your home by wearing a tiny device on your arm or on a headband type thing.  Once you have spent the night at a sleep lab, the doctors will read the data sometime over the next few weeks hopefully and tell you the results.  If you stop breathing many times during the night for example, you just might have obstructive sleep apnea.

Local Sleep Doctors:

Many towns or cities might have a local sleep doctor.  This is someone who is a member of the Board of Sleep Physicians and has been trained in understanding how important sleep is to the human body and they are usually pretty good in figuring out if somebody has a sleep disorder.  Some local sleep doctors own their own sleep labs.  It sometimes is like a hotel environment, where you have several different “beds” as they are called, with private rooms that have all the monitoring equipment.  Usually if you have a sleep test at one of these places, there will be an overnight medical technician type person who will be there with you checking up on you throughout the night too.

The much cheaper and usually easier option that these labs might offer is for you to take home the home testing equipment.  But beware, the sleep labs make much more money if you spend the night there, which also means you pay much more, so I would opt for the home test if it was me, obviously.

HMO and Sleep Studies for Sleep Apnea:

Many HMO groups also own their own sleep labs.  Some of these labs also offer home testing.  Since the home testing is so much cheaper, they usually ask that the HMO patients who need sleep studies use a home test.  What you want to watch out for is if you are a PPO patient and need a sleep study, you still have a choice as to where you and how you want to get your sleep test.  Some medical foundations that own their own sleep labs try to have their HMO patients do the home test to save on costs, while asking their PPO patients to complete a full in lab overnight study so they can charge the insurance a much higher amount.  When I say higher amount, we easily could be talking about the difference between a charge of $750 for a home test compared to over $5000 for an in lab test if you are a PPO patient.  So yes, its very substantial.

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