Wednesday, October 12, 2011

Insurance companies requiring Home Sleep Tests prior to the Sleep Lab!

United Health Care appears to be the leader in the push to bring Home Sleep Testing (HST) to the forefront of diagnostic sleep medicine. As of October 1st, all UnitedHealthcareWEST, Neighborhood Health Partnership and River Vally members will be required to have a pre-authorization for all sleep studies. If a provider attempts to perform an in-lab study on a patient who meets United's criteria for a Home Sleep Test, their pre-authorization will be denied. This denial will in turn leave HST as their only available option to diagnose the patient's sleep disordered breathing. United's new policy will also require patients to undergo at-home titrations using Auto-Titrating CPAP devices, in the place of in-lab titrations when appropriate. (click here to read United's Official Policy).

Last month Premera Blue Cross (a Blue Cross licensee out of Washington) announced its plans to mimic United's approach to diagnostic sleep medicine. These changes were announced just one month prior to when United's policy was to become effective (click here to read the Premere Blue Cross official policy).

Given the fact that cuts in Medicare are likely to occur in the next few years, we can expect to see more and more insurance companies start to accept the HST model. If Medicare decides to start pushing its patients towards the HST model, this would break up the near monopoly of diagnostic sleep medicine that sleep labs have long enjoyed. Instead of being the source for the majority of all sleep diagnostic needs, sleep labs will eventually become the secondary source for diagnosis, relegated to studying patients who do not qualify for HST (cheyne-stokes breathing, neuromuscular disorders, pulmonary issues, etc).

While the HST model will ultimately save the payers money, many feel that its implementation will not be in the best interest of the patient. Individuals with pulmonary issues, cardiac problems and neurological problems (PLM's, RLS, etc) that are undiagnosed, will likely have have to wait longer to receive therapy. Since these disorders are easily identifiable during an in-lab sleep test, patients with these issues currently receive expedient care. This is because overnight tests often detect many other disorders, aside from sleep disordered breathing. Under the HST model these patients will first have to undergo a HST which (depending on the unit used) will likely not pick up any of these disorders. They will then have to return to their physician who will likely have to refer them to an overnight facility where these types of disorders can be observed.
-Mr. Sleep


Premera Blue Cross. (2011). Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome and

Upper Airway Resistance Syndrome


United Healthcare Online. (2011). July 2011, Network Bulletin. https://www.unitedhealthcareo


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