Medicare Pays More For Sleep Apnea Problems

The treatment of sleep disorders has progressed in recent years.  Today, doctors with special training diagnose and treat more than 80 sleep disorders.  These range from obstructive sleep apnea to narcolepsy. 

Snoring on its own is not a medical problem.  “Insurance generally won’t cover its treatment, to the great disappointment of many a snorer’s bed partner,” explains Jesse Slome, executive director of the American Association for Long-Term Care Insurance, an insurance industry trade organization.  “This is a health issue facing a growing number of aging individuals.”

Obstructive sleep apnea affects between two and four percent of Americans.  “The consequences of untreated sleep apnea can be extremely serious,” Slome explains.  Sleep apnea is an obstruction of your airway that’s created when the muscles at the back of your throat relax during sleep. The obstruction partially or completely stops your breathing, sometimes for a minute or longer, until your brain alerts your body to wake up and you start to breathe again. This can lead to fragmented, poor sleep as well as reduced oxygen levels, which can worsen such medical conditions as high blood pressure and diabetes and increase your risk of heart attack and stroke.

According to medical experts, as awareness of the problem has increased, so has demand for testing and treatment. Patients with suspected sleep apnea are typically sent to sleep centers where they are evaluated overnight while they sleep.

Over the past decade, the number of accredited sleep centers has grown from just over 550 to over 2,200 according to the American Academy of Sleep Medicine.

Medicare payments for sleep lab testing have increased from $62 million in 2001 to $235 million in 2009, according to the Department of Health and Human Services’ Office of the Inspector General, which is conducting a study to review the appropriateness of Medicare payments for them. The study is due next year.

Insurance will generally cover either type of test if it is prescribed by a physician.   Good news for seniors: Private insurers have covered the dental appliances for years, according to the American Academy of Dental Sleep Medicine. In January, Medicare began covering them, too.

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