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 (
Does insurance cover sleep studies?
The majority of sleep disorder centers operate similarly to a typical doctor’s office and accept a variety of insurance carriers. This can make the entire process of undergoing a sleep study much easier, though it’s always a good idea to check with your insurance company and plan ahead of time to see if sleep study charges are covered. Insurance companies are there to assist you, so don’t be scared to inquire.
There is no way to know exactly how much a sleep study will cost. Some sleep problem clinics charge as low as $600 per night, while others charge as much as $5,000. The amount of money covered by insurance varies due to the varied costs of studies.
When a patient pays their insurance deductible, it has an impact on how much money they have to spend out of pocket.
Is sleep apnea covered by insurance in India?
Dr. Sumant Mantri: Medical insurance companies still don’t recognize sleep apnea: Dr. Sumant Mantri, ET HealthWorld’s Health News.
How much does a sleep study cost in India?
However, you can now take this test in the privacy of your own home. The majority of sleep specialists rent out sleep test kits for Rs 2,000-4,000 each night. PSG tests, on the other hand, can cost up to Rs 15,000 and can only be done in a hospital or a sleep clinic.
Why won’t my insurance cover 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 qualifies you for a sleep study?
If you experience signs of sleep apnea, such as heavy snoring and being sleepy during the day, your doctor may recommend a sleep study. Sleep apnea puts you at risk for a variety of other health issues. Sleep deprivation lowers your quality of life and raises safety concerns.
Is snoring surgery covered by insurance?
Your insurance may cover some snoring operations. When your snoring is caused by a diagnosable medical condition, such as obstructive sleep apnea, surgery is frequently covered. Snoring surgery might cost several hundred to several thousand dollars without insurance. It might cost up to $10,000 if you don’t have insurance.
What is CPAP pillow?
Sleep apnea, a respiratory disorder that affects millions of Americans, is treated with continuous positive airway pressure (CPAP). While CPAP therapy is very effective, some people find it difficult to acclimate to the mask they must wear every night. CPAP pillows are one of the most popular accessories for ensuring a good night’s sleep while using a CPAP machine, and they can make treatment more comfortable.
CPAP pillows are pillows that are meant to hold a CPAP mask. They are not to be confused with CPAP nasal pillows, which are a form of low-profile mask. They come in a variety of shapes and sizes, but most contain cut-outs or curves to allow CPAP users to sleep on their side without their mask pressing into their skin. Other designs, rather of being accommodating, may be adjustable or stabilizing. An active sleeper’s mask is less likely to dislodge using a CPAP pillow, which may improve treatment efficacy.
Your personal tastes and budget, as well as the type of mask you use and your favorite sleeping position, all play a role in selecting the best CPAP pillow. We’ll show you some of our favorite models before going over the most crucial things to think about before making a purchase.
How much does polysomnography cost?
How much does a polysomnography (sleep study) cost? A Sleep Study (Polysomnography) can cost anything from $943 and $2,798 on MDsave. Those with high deductible health plans or those who do not have insurance might save money by purchasing their procedure in advance with MDsave.