For most patients, CPAP is an unusual treatment in which the patient is required to use a machine that pushes air under pressure to keep the airway open rather than merely taking a tablet. Only between 17 percent to 54 percent of patients continue to use CPAP. 4 The majority of the adherence data available comes from Western countries, where cost is not a big barrier to acquiring CPAP because the majority of the population is insured, and CPAP is covered by private insurance companies. In India, however, private insurance firms do not cover CPAP, and only a few government employees are reimbursed for CPAP expenses.
Data on CPAP adherence and the financial constraints to purchasing CPAP from Indiaor any other third-world countryis rare in the extant literature. The current study’s goals were to report CPAP adherence rates and identify reasons for non-adherence in Indian patients with OSA. The most common reason for nonadherence, according to our research, is resistance at the very first step (i.e., purchasing/acquiring the CPAP device). This is demonstrated by the fact that 24 of the 29 patients who purchased CPAP used it for around 6 hours per night (82.7 percent CPAP buyers were adherent). Overall, 30.3 percent of people followed the rules (24 of 79 patients).
We compared their income to individuals who did not buy a CPAP device due to financial constraints because around 25% of CPAP device buyers reported they had trouble acquiring money for a CPAP device. There was no difference in income between these two groups, according to our findings. This shows that the patient’s attitude and thinking could be a stumbling block in the purchasing of a CPAP machine. In India, obstructive sleep apnea (OSA) is regarded as a “snoring” illness. Patients and doctors alike have limited knowledge of the problems, which may contribute to patients’ view that CPAP treatment is not worth the money.
In India, private insurance companies do not cover CPAP, and only a few government employees are compensated for CPAP costs. When comparing patients who had access to CPAP equipment reimbursement to those who did not, there was no difference in purchasing behavior. This could be attributed to a lack of societal knowledge of OSA as a condition, as well as patient attitudes about the disorder.
We discovered that sex or socioeconomic position (as measured by the modified Kuppuswami scale) had no effect on CPAP compliance or purchasing behavior. Female sex was discovered to be a barrier in CPAP acceptability in an Israeli study looking for markers of long-term CPAP use. 11 Despite the fact that female health is commonly overlooked in India, we found no evidence of a sex effect on CPAP acceptance in our study.
Although prior research has suggested that rising age increases CPAP acceptance8, age was not found to be a significant factor in influencing adherence or the purchase of a CPAP device in our study.
Adherence to CPAP therapy has been proven to be influenced by education in the past.
8,9 Patients who lived in communities with a larger number of graduates were shown to be more inclined to stick to their treatment regimen. In contrast, we found no evidence that adherence was influenced by the patient’s educational position in some previous studies12, including the one we conducted. Smoking and drinking alcohol had no effect on adherence in our study, while some investigations reported that smoking or drinking alcohol had a negative effect on overall adherence to CPAP therapy. 1113
Severe OSA is frequently related with obesity hypoventilation syndrome. Patients with obesity hypoventilation syndrome were 3.4 times more likely to purchase a CPAP equipment and 5 times more likely to stick to CPAP therapy than those who did not. This indicates that the more serious the ailment is, the more likely people are to seek treatment.
Patients with more severe OSA (higher AHI, lower nadir oxygen saturation) were also more likely to purchase and utilize a CPAP machine than those with less severe OSA. This finding is consistent with previous research, which found that the severity of the condition was one of the most critical criteria in affecting adherence. 8,11,12,14 Patients with a CPAP pressure of more than 10 cm H2O were found to be 5 times more likely to purchase and 7.2 times more likely to adhere to treatment. CPAP pressures greater than 10 cm H2O have been linked to CPAP compliance. 15 One probable explanation is that more severe OSA usually necessitates more pressure, hence individuals with more severe OSA who require higher pressure are more adherent than patients who require less CPAP.
Although another study found a link between hypertension and higher compliance in the form of an increase in the number of days of use, our research found no link between hypertension and any other OSA comorbidity.
13
One of the primary goals of our research was to identify the hurdles to CPAP use in Indian patients. There have been very few studies in the past that looked at cost as a barrier. The expense of a CPAP device was found to be one of the key causes in a study conducted in Israel (where CPAP therapy is not covered by insurance), along with CPAP side effects, failure to adjust to therapy, and patients desiring to try other therapies. 8 Poor titration night experience was the most important factor in a study conducted in Canada (where health insurance covered the cost of CPAP). 7
Many people in India do not have health insurance, and those that do do not have insurance that covers CPAP therapy. The most important barrier to CPAP therapy in our study was budgetary restrictions. In a survey of 50 nonbuyers, 34 (68%) said it was one of the reasons, and 30 (54.5%) said it was the most important reason for not being able to acquire CPAP (
Is CPAP covered by insurance in India?
Is sleep apnea considered a pre-existing condition by health insurers? Yes, it is correct. After a specific waiting period, any pre-existing ailment is covered.
Does sleep apnea affect insurance?
When you apply for insurance, insurers will want to know if you have a chronic disease like sleep apnea. Even if you have sleep apnea, life insurance is still an option. It won’t immediately exclude you from purchasing life insurance, but it may limit the type of coverage you can acquire.
Can you be denied life insurance for sleep apnea?
Does sleep apnea make you ineligible for life insurance? Sleep apnea does not automatically rule you out of getting life insurance. You may receive higher prices, but if you’re treating your ailment and otherwise appearing to be in better or increasing health, you might not have to spend much more.
Can I claim benefits if I have sleep apnea?
Sleep apnea is no longer listed as a disability by the Social Security Administration (SSA), but it does include entries for respiratory disorders, cardiac problems, and mental deficiencies. You would immediately qualify for disability benefits if you match the criteria of one of the categories owing to your sleep apnea.
Is sleep apnea a terminal illness?
Although a person with sleep apnea does not always die while sleeping, the chance of death rises dramatically if the condition is left untreated. When the brain detects a lack of oxygen, it tells the body to wake up, which is why patients with sleep apnea do not frequently die in their sleep.
Can you get life insurance with a CPAP machine?
The sole side effect of sleep apnea is a fatigued partner who is awake all night due to your snoring.
Sleep apnea is a chronic condition in which breathing stops and begins periodically during sleep. Carbon dioxide builds up in the bloodstream when breathing is stopped. The brain is then told to rouse the sleeping individual and breathe in air, thanks to a receptor in the circulation.
Breathing regularly again restores oxygen levels, and the person falls asleep again. It’s uncommon for the person to even notice they’re having trouble breathing.
If left untreated, sleep apnea can cause hypertension, cardiac difficulties, lung damage, a lack of attention, and an increased risk of car accidents. Because of these possibilities, the life insurance market scrutinizes candidates who suffer from sleep apnea.
Why would my insurance deny a sleep study?
Is it true that sleep studies are covered by insurance? The short answer is YES; practically all insurance companies fund sleep testing. Some insurance plans, however, have different regulations about sleep studies than others. Some insurance policies, for example, will demand a Home Sleep Test (HST) before they will fund an in-lab test (PSG). Because HSTs can accurately diagnose 75 percent of individuals with sleep apnea who have been thoroughly screened by a physician, ordering the more expensive (but more accurate) PSG scan isn’t always necessary.
Important insurance jargon to be familiar with
Some of the misconception about how much a patient must pay for services originates from a misinterpretation of language used by insurance companies in their policies. We’ll try to explain these often-confusing terminology that characterize your policy in this section.
In-network.
When arranging a sleep study with a clinic, one of the most important things to look for is whether or not your insurance provider is “in-network” with the clinic. When a clinic is in-network with your insurance provider, it indicates the two parties have agreed on a lower pricing for treatments. For example, our basic charge for a CPAP titration is $4,000 (before physician expenses), however that rate is substantially reduced for insurance carriers with which we are in-network. We’re in-network with a particular company, and the fee is $2700, a savings of $1300 over the initial amount.
This implies that if we are in-network with your insurance, your insurer will pay a lower pre-determined cost for our services, and you will spend less of your own money. If the clinic you’re going to is out-of-network, they’ll either have to pay a higher rate, they’ll only agree to pay a set amount, leaving you to pay extra, or they’ll refuse to pay the entire cost, leaving you to foot the price.
Check with your insurance to see which clinics are in-network before scheduling a sleep study so you don’t end up with a bigger fee.
Deductible
Your deductible is the amount you must pay each year before your insurance will pay for any services.
Let’s say you come to our clinic for a titration study and your insurance plan’s in-network fee is $2700, but your deductible is $1000 and you haven’t had any other services this year. Before your insurance begins to cover anything, you will normally have to pay $1000 out of pocket. This isn’t even a guarantee that your insurance will cover the remaining $1700. The amount they pay for the rest is also determined by your coinsurance.
Coinsurance
Your coinsurance is the portion of the cost of a health-care service that you share. It’s commonly calculated as a percentage of the overall service fee. After you’ve paid your deductible, you’ll start paying coinsurance.
Let’s get back to that $1700 cost once you’ve reached your deductible. A standard coinsurance percentage is 20%, which means your insurance will cover 80% of the cost and you will cover 20% of the remaining $1700. Your insurance will cover $1,360, while you will be responsible for $340. When you factor in the deductible, the total cost of treatments in this instance is $1,340.
Copay
A copay is a set amount you pay for a health-care treatment at the time you receive it. The majority of copays are for filling medications and only rarely for services like sleep studies, however your insurer may require you to pay a small upfront amount at the time of service. Depending on the type of service, the amount may differ.
Out-of-pocket
The maximum amount you will spend out of pocket for approved medical expenses in a particular year is known as out-of-pocket.
Many insurance plans will require you to meet a deductible before moving on to a coinsurance percentage that you will be responsible for up to a certain amount. Once you’ve reached that amount and paid your maximum out-of-pocket limit, your insurance will normally start paying for 100% of the charges.
While having a sleep study done at the beginning of the year may cost you some money, once you’ve met your out-of-pocket fees, your insurance will usually cover the balance of the services. These costs could include your CPAP machines, masks, hoses, and other therapy-related durable medical equipment (DME).
It’s also important to make sure that when the year draws to a close and you’ve paid off all of your out-of-pocket expenses, you’re up to date on all of your DME equipment so that your insurance will cover it, rather than having to pay for it yourself at the start of the next calendar year.
What if you don’t have insurance?
We never turn anyone away who is suffering from a sleep condition at The Alaska Sleep Clinic, regardless of whether or not they have insurance. We will always work with patients to find solutions to cover services.
We also provide a 20% discount on all cash-pay services if you pay with cash. We think that a person’s financial condition should never prevent them from getting treatment for debilitating sleep disorders, and we are happy to work out payment plans with them.
Questions to ask your insurance company and other considerations
Learn everything you can about your policy. This entails being aware of your premiums, covered services, deductibles, coinsurance, copays, and out-of-pocket costs.
If your primary care physician refers you to a clinic, double-check that the clinic is in your insurance’s network.
An insurance company will refuse to pay for a sleep study if they believe it is medically unnecessary. Your doctor may recommend a research, but your insurance company may object. Because a PSG is not medically essential, your insurance company may consent to a HST. Once your HST has been examined by a sleep specialist and it has been determined that a PSG is medically necessary, your insurance company may agree to cover the cost of the procedure. If you do the PSG first, they may refuse to pay the charges.
Insurance companies follow extremely strict guidelines for sleep studies, taking into account comorbidities and previous medical history. If you’re not sure if you’re covered, call your insurance provider and find out what you need to do to submit a study pre-determination request.
We undertake insurance verification as a convenience to patients at The Alaska Sleep Clinic in order to prepare a price quote. This price quote, however, is only an estimate of your payment part and not a firm amount that you will pay.
If you’re ready to arrange a sleep study and have checked with your insurance provider about your coverage options, contact The Alaska Sleep Clinic to set up an appointment, and we’ll help you get started on treating your sleep condition.
What are the 3 types of sleep apnea?
There are three different types of sleep apnea. The fundamental distinctions between obstructive sleep apnea, central sleep apnea, and complicated sleep apnea are listed below.
How many apneas per hour is normal?
That’s because having up to four apneas every hour is considered typical for everyone. It’s also usual if your AHIs fluctuate from one night to the next. Depending on the severity of your sleep apnea, even greater AHIs may be tolerable for some CPAP users.
What happens if sleep apnea goes untreated?
Sleep apnea can lead to a variety of health issues, including hypertension, stroke, arrhythmias, cardiomyopathy (enlargement of the heart muscle tissue), heart failure, diabetes, obesity, and heart attacks if left untreated.
Because sleep apnea is associated with high blood pressure, it’s likely that it can lead to arrhythmias and heart failure. Sleep apnea affects roughly half of all persons with heart failure or atrial fibrillation.
Due to the high occurrence of sleep apnea in cardiac arrhythmias and heart failure (it’s virtually a coin flip whether the patient has it), doctors advise that you seek medical help as soon as possible.
