If you find you or your partner are struggling with disrupted sleep and suffering from a condition such as sleep apnoea, you’re not alone.
According to the Victorian Government, around five per cent of Australians have sleep apnoea.
And while it affects both men and women, it is more common in men, especially aged 30+ where it is three times more common in men than women.
What is sleep apnoea?
Sleep apnoea is a condition that sees a person’s breathing repeatedly stop and start during sleep. Depending on the severity, an ‘apnoea’ – when the breathing stops – can last between 10 and 90 seconds and happen multiple times throughout the night. When the brain finally registers a lack of oxygen, it rouses the body briefly so breathing can start again.
There are three types of sleep apnoea – Obstructive, Central and Mixed. Mixed is the most common and occurs when the airway is blocked by the relaxation of muscles in the back of the throat and the tongue. Central is when the brain doesn’t send the right signals to the muscles that control breathing and Mixed is a combination of Obstructive and Central.
Sleep apnoea causes sleep disruption, puts significant strain on the body and can increase the likelihood of long-term health problems, such as diabetes, heart failure, stroke and mental health concerns.
Are sleep studies usually covered by insurance?
While diet and lifestyle changes such as healthy sleeping habits, limiting alcohol, giving up smoking and managing weight can help you manage the condition, medical treatment may also be necessary. Health insurance can help you there.
Eligible Australians can access a Medicare rebate for sleep study services to clinically assess and diagnose sleep disorders. A general practitioner or sleep specialist must determine that a person has a high probability for symptomatic, moderate to severe obstructive sleep apnoea, using a series of approved screening questions, to be able to refer them for an overnight diagnostic assessment.
Some private health insurance policies cover the diagnosis and treatments of sleep disorders, and when used with the Medicare rebate, can potentially reduce your out-of-pocket costs. Health insurance can also offer you more choice and convenience of care, but you will need to read the fine print on your insurance policy to determine just how much is covered by your health insurance.
Also, if your sleep assessment reveals you require Continuous Positive Airway Pressure (CPAP) therapy to treat your sleep apnoea, for example, Medicare may also cover some of those costs. If you have a private health insurance extras policy that covers this treatment, your health insurance may also contribute to the cost.
How does health insurance cover sleep apnoea studies?
While health insurance policies can vary significantly from one another, the levels of basic, bronze, silver and gold for hospital cover offers a standardised perspective on what you can expect to pay for the services, conveniences and peace-of-mind you require.
If you purchase gold level hospital cover, you are guaranteed to be covered for sleep studies. However, that doesn’t mean other levels of cover won’t offer cover as it’s optional for health funds to provide clinical sleep studies on policies in other levels of hospital insurance, so you’ll need to do your homework to find a policy and level of cover that suits you, your requirements and your budget. Silver Plus policies, for instance, may be an alternative worth investigating.
While policies do vary, generally you can expect more options and conveniences, such as your choice of specialist and hospital from private cover that you wouldn’t otherwise receive from Medicare. But, depending on your policy, you may also be limited by waiting periods and have to pay an excess fee. So always check your policy’s fine print or speak to your health fund directly about exactly what your policy covers and the out-of-pocket costs you can expect to pay.
Find more valuable health cover
How much does a sleep study cost out of pocket?
According to HCF’s online cost calculator, which is based on HCF claims data from March 1 2019 to February 29 2020, hypothetically, an adult who has a private health insurance policy with an excess fee of $500, who undertakes a sleep study at a private nonparticipating hospital, at an average total cost of $3403, can expect to pay out-of-pocket costs of $559 for the test.
The health insurer will pay 42 per cent of those costs, Medicare will pay 44 per cent and the patient can expect to pay 14 per cent. Of course, this can vary widely and will depend on the policy cover, the chosen policy excess and the doctor’s fees and charges.
Public patients in a public hospital can expect Medicare to foot some of the bill but depending on your circumstances and eligibility, there may be some out-of-pocket costs.
Subsidised at-home sleep study tests are also available to eligible Medicare patients – some are even bulk-billed – but these are limited to one per year.
RELATED: Does private health insurance guarantee better healthcare?
Originally published as Does health insurance cover sleep apnoea and sleep studies?
ncG1vNJzZmivp6x7r7HWrGWcp51jrrZ7wqGcnKOfqsFwuMifnGiln6OyunvHnpilrJhitq%2B%2F1KuYp5uVYsCtscSpZKyspZm2pr%2BOp5ywq12owbC%2B2GibbJmWboJ5fsNrmJxqkpiBdIHAbpxyb2SZgXV%2BxG6caQ%3D%3D