Insurance - Frequently Asked Questions
I don’t know about you, but if I don’t have to pay full price for something, I am more likely to indulge!
Sales get me every time!
Even if it is just 10% off.
The same applies goes for medical expenses!
We all know how expensive doctor’s visits can be, and Sleeptopia is here to alleviate those punches to the pocketbook!
Instead of in-lab home sleep test costs which can range up to a few thousand per night, Sleeptopia is a fraction of that huge chunk!
We work with your insurance or financial for your benefit!
Will insurance cover my HST? We are in network with most insurance companies! Sleeptopia enjoys in-network status with Aetna, BCBS, Cigna, Coventry, Medicare, Tricare just to name a few. All of those and many more!
Will insurance cover CPAP supplies? Yes! Most insurance will cover CPAP and supplies and are subject to your plan’s deductibles, coinsurance, and out of pocket maximum.
What is a deductible? A deductible is the amount you pay for covered health care services before your insurance plan starts to pay receipts after adjustments. After you pay or meet your deductible, you will end up paying only a copayment or coinsurance for covered services. Your insurance company will pay the rest.
How do I find out what my deductible is? Call your insurance company or read your benefits paperwork to verify the deductible you owe. Your deductible will also be listed on your Explanation of Benefits (EOB). You'll want to meet your deductible early in the year, if possible.
What is EOB? EOB stands for Explanation of Benefits. The most important thing for you to remember is an EOB is NOT a bill. It’s a statement from your health insurance plan describing what costs it will cover for medical care or products you've received. The EOB is generated when your provider submits a claim for the services you received. The insurance company sends you EOBs to help make clear: The cost of the care you received. For example, Sleeptopia will file a claim for a home sleep study on your behalf which includes the cost of the home sleep test, the billing code, and any other information that is requested (depending on the insurance company).
What is my cost? The cost for a home sleep study is solely determined on your insurance. We do offer self pay prices. If you have a high deductible, we do offer the self pay option for those whose insurance may not cover much of their home sleep study. Call our office if you have questions about the Self Pay Option.
How often can I get supplies through insurance? You can get 1 full-face cushion if you have a full face mask, or 2 nasal cushions or pillows (determined by your mask) every month! Every three months, you are able to get a new mask frame (the part of the mask that separates from the headgear and that piece that the cushion goes into along) and tubing for your machine with the monthly supplies. Every six months, you are able to get a water humidifier and the mask headgear (the felt straps that are placed around the crown of your head. We do have options for supplies too! We can set up automatic calls to see what supplies you are needing, you can go to our website to the CPAP & Supplies section and fill out the form at the bottom of the page, or we can set you up for autoship to automatically send out the supplies for your machine according to the notes we have on file.
What if I don’t have insurance? No insurance? No problem! No worries! We have a self pay price for those who have high deductibles or no insurance at all! We know that the recent pandemic has not gone easy on anyone. We understand and we are here to help! We want to offer the best options for you! Maybe there is an issue with income, extra funds, or issues with finances. If so, we can always work out a solution.
What is the cost of in home vs in the lab? The in-lab sleep study test can vary with a range in price from $500 to more than $3000. Good news! Your insurance plan coverage will determine the actual out-of-pocket expense that you will incur for the in-lab sleep test. That out-of-pocket expense will be determined on your deductible, allowables, and adjustments that is determined by the insurance plan that you are on. In some cases, insurance may only pay for a small portion of this test. For in-home sleep tests with Sleeptopia, we will file an insurance claim for your sleep study on your behalf, and fight for the best price for your out-of-pocket payment! Sometimes, depending on the deductible, it may be more expensive. If by chance, that happens, we offer an assortment of payment plans that fit any and every budget. Our specialty is making sure that you are comfortable and taken care of throughout the entire process.