(Updated 2022) Second of two parts. Here’s the first.
About an hour before Karin S.’s bedtime, two people in lab coats knocked on her door in Queens, New York. They were there to put her to bed for a sleep apnea test. They followed her to the bedroom and attached sensors and electrodes to her scalp, face, hands and chest. They hooked her up to a polysomnography machine. As she slept, it recorded a wide array of body functions, including heart rate and rhythm; breathing; nasal airflow; the amount of oxygen in her blood; and brain activity. They returned very early the next morning. They unhooked her and retrieved the machine and the results.
Karin’s first sleep study was performed at home through an independent sleep clinic. Years later, her second study was performed overnight in a hospital.
“It’s much more invasive in the lab,” she said. “They watch you all night long and videotape you.”
The first procedure was part of a medical study, so she incurred no costs. Karin did not share her medical bills with us, but she did say that the second procedure was mostly covered by her insurance. She paid a 20 percent co-pay fee upfront.
The difference in sleep study results, and a sleep apnea diagnosis
She also told us that both the home and hospital tests were conducted in basically the same way. However, the results she received from the hospital were more informative.
“They told me about the architecture of my sleep,” she said, “and they could describe where the problems were.”
They also told her she had sleep apnea.
Sleep apnea is an obstruction of the upper airway that blocks breath while sleeping. It manifests by loud snoring and a low oxygen concentration in the blood. People often wake during the night, even for brief moments, resulting in a kind of “sleep fragmentation” that leads to daytime drowsiness.
It’s a potentially life-threatening condition. According to the World Health Organization, sleep apnea affects between one and six percent of the adult population, with a greater prevalence in men.
Karin was fitted with a CPAP mask and given a machine that regulated airflow. Her insurance covered the cost. But not long after, her insurance coverage changed and the new carrier declined to pay for the machine.
Today, CPAP machines are generally maintained by the hospital or clinic where the study is performed. But when Karin got her first CPAP machine, she had to rent it from a medical supply company. They charged her a $400 up-front fee and $10 a month thereafter.
At the time, money was tight. Karin was also required to pay out-of-pocket for filters, tubes and masks. “I wore the same mask for three years,” she said.
Now her insurance covers the cost. Her new CPAP machine has a memory card that records her breathing and quality of sleep. “It tells the doctor if I’ve been using the machine,” Karin said. “I’m a loud snorer, so if I don’t use it, my family doesn’t get sleep.”
It’s not clear that every provider is consistent about using the same medical coding practices, which is particularly true here. Online communities discuss what kind of sleep study is given the medical billing code 95810 (generally, but not always, a polysomnography or polysomnogram) and what is a 95811 (again, generally, but not always, a split-night study), so if you’re confused rest assured that others are too. Here’s a page online discussing medical coding for sleep studies, in which several people relate how they do it. The differences are striking.
Here’s a page of New York area polysomnography sleep study fees for a cash or self-pay patient. Here are New York area split-night sleep study prices.
Here’s a page of Los Angeles area polysomnography sleep study fees for a cash or self-pay patient. Here are Los Angeles area split-night sleep study prices.
Here’s a page of Dallas-Fort Worth area polysomnography sleep study fees for a cash or self-pay patient. Here are Dallas-Fort Worth area split-night sleep study prices.
How much does a sleep study cost? The takeaway.
The price range is huge. As always, if you’re insured, make sure it’s covered, in network, and so on. Here are some questions to ask.
- Be sure that you need a sleep study, and know which kind is being recommended and why.(For details, look at the first post in this series, which is here.)
- If you’ve got health insurance, will this be covered by your insurance policy? We have heard that doctors’ recommendations are sometimes rejected for payment after the fact by insurers. Always ask first.
- We recommend that you shop around. If your provider sends you to a facility, ask if it takes part in your insurance plan, meaning that it’s in your network. Take notes, take names, take dates.
- Ask how much it will cost. Ask how much it will cost you. You can also ask if there’s a lower-priced alternative that will deliver the same results.
- Ask: what is the total charge? Are there facility fees, lab tests? Is there an interpretation fee? A reading fee? Does the doctor charge a separate fee?
- How much are initial and follow-up visits? Will they be covered?
- This guide to interpreting results is fairly thorough. The American Sleep Association, a trade group, offers these details about sleep studies.
Part 2: How to argue a bill.