Sleep Apnea is the temporary cessation of breathing during sleep and or airway obstruction. The purpose of this program is to educate the member as to causes of sleep apnea, and to provide guidance to the member regarding the plan benefit and the importance of using participating providers.
- All sleep studies REQUIRE Pre-certification by a YourChoice Nurse Advocate.
- A physician who specializes in Sleep Disorders (Diplomat of the American Board of Sleep Medicine) will supervise and interpret all Sleep Studies.
- Pre-test evaluation by a Physician who is a Diplomat of the American Board of Sleep Medicine is required when a sleep study is recommended by the primary care physician.
Medical Equipment Utilized for Sleep Apnea
If equipment is needed and ordered by the appropriate physician, the equipment must be issued through a network provider.
The equipment is rented initially for approximately 90 days. A Nurse Advocate will call you monthly for the first 3 months to assist with issues that may arise while adjusting to the equipment. We want you to be satisfied with the equipment and the treatment plan set forth by your physician.
Sleep Disorder Benefit
The Plan covers consultation and diagnostic testing for sleep apnea, a temporary cessation of breathing during sleep and or airway obstruction.
An In-Network Provider MUST provide these services. No benefit will be paid to an Out of Network provider
The plan benefit pays according to your level of benefit (Basic, Better, Best or Ultimate) at the time of service. The Member is responsible for any and all deductible and co-insurance according to the level of benefit (Basic, Better, Best or Ultimate) at the time of service.
Refer to the current Benefit Guide regarding benefit details.
To get started or for more information, contact Your Nurse Advocate.
More Information About Sleep Apnea
The Greek word "apnea" literally means "without breath." There are three types of apnea: obstructive, central, and mixed; of the three, obstructive is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.
Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.
Sleep apnea is very common, as common as adult diabetes, and affects more than twelve million Americans, according to the National Institutes of Health. Risk factors include being male, overweight, and over the age of forty, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.
Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues.
American Sleep Apnea Association:
1424 K Street NW, Suite 302, Washington, DC 20005