How am I billed for a sleep study?
When you have completed a sleep study, and the interpretation is completed by the MD, your insurance is billed. Processing by the insurance company can take up to 30 days to complete. You will receive an "Explanation of Benefits" (EOB) statement from your insurance company showing what was paid to SCSDMC for performing your overnight sleep study. The patient is responsible for paying any applicable deductibles, and co-insurance (patient portion) as agreed upon between you and your insurance.
How does health insurance cover the charges for a sleep study?
Every health plan has a different amount that they agree to pay for a sleep study. Please familiarize yourself with your insurance plan, and be aware of any deductibles that have not been met. Generally speaking, the insurance will pay a portion of the billed charges or the "allowable amount". This "allowable amount" varies from plan to plan. As a courtesy, the difference between what is billed to your insurance and the "allowable amount" is adjusted off your bill. You will be responsible for the patient portion of the allowable amount, which again varies from plan to plan.
(SCSDMC Billed Charges) - (Allowable Amount) = "Adjustment" Amount
(Allowable Amount)- (Insurance Payment Amount) = Patient portion due
What health insurance plans have an "in- network provider agreement" with SCSDMC?
(The following list reflects current contracts; these may change at any time. Please contact the office immediately if you have a change of insurance or demographics)
· Aetna
· Beech Street PPO
· Blue Shield PPO
· Cigna PPO
· Great West Healthcare of California
· Humana ChoiceCare Network
· Interplan Health Group
· Medicare
· Tricare
What do I do if SCSDMC is not contracted with my insurance?
If your plan does not have an "in-network" contract agreement with SCSDMC, your co- insurance (patient portion) may be different. Please contact your insurance plan for the out-of network amounts. As a courtesy, we try to minimize the difference between what you may pay "out of network" vs. "in network". Our biller can also assist you in this process.
Are there any other payment options?
Cash discount: If you would like to pay cash for your sleep study, a cash discount is offered and is equal to 110% of current Medicare rates. Please call the office with questions.
Payment plans: If you are unable to pay all at once, payment plans are available.
Who can assist me with my insurance at SCSDMC, and what are the billing codes used for a sleep study?
Our experienced insurance billing specialist, Tracy, can be contacted at the office at 408-356-8900 for questions regarding payment for your sleep study. Please also call your insurance company for specifics regarding your plan.
Codes used:
· Overnight Diagnostic Sleep Study (Polysomnogram-Diagnostic):
95810
· Overnight Therapeutic/ Titration Sleep Study (Polysomnogram-Titration):
95811
· Multiple Sleep Latency Test (MSLT):
95805
Photos a Courtesy of Hetta Malone, hettamalone@sbcglobal.net
