The last two years have seen a great deal of change in health insurance and this has affected the care of people with sleep apnea. It is part of the job of a sleep lab manager to keep up with these changes so we can make sure that the patient receives the best service possible. The biggest problem we face is that many times the patient does not understand the changes that have taken place. If you are able to explain these changes effectively you might avoid a patient’s negative experience.
One big issue seems to be the most difficult with those patients who need a replacement machine. People who have older machines many no longer qualify for CPAP simply because the qualifications have changed. Respiratory events have a different definition today than they did 10 years ago. Documentation was also different 5 or more years ago. You need to make sure you have documentation that meets current standards when going to order a new machine.
The other issue that is becoming more influential on sleep patients is riders and deductibles. Today many patients have significantly higher deductibles they have to meet. This can cause financial hardships in having tests done and getting their CPAP equipment. Many people do not know the nuts and bolts of their insurance policy. If we can be of help in explaining what is going on and why we bill the way we do they will leave with a positive experience even if they do not end up having a test due to the cost. But if all you say is that “your insurance company says that your test will cost you x dollars,” the patient will only leave with a feeling of being short changed by your facility. Instead if we understand that the patient has a large deductible and that although when you visit the doctor you pay a copay if does not cover deductibles, instead the deductible applies only to everything that happens outside the doctor’s office, they will get a clearer picture.
It also helps to reduce the non pays for the lab. In our lab we rarely get an insurance company denial. The ones we do get usually get paid when we submit additional paperwork. This reduction in denials helps us make more cash flow overall and allows us to grow. It gives everyone in the lab job security.
In the end it is important to be a strong resource for our community. Knowledge about how insurance works is a great way to start. If you are an avid reader or you have access to the people in the billing department of the practice you can gain the knowledge you need.