![]() ![]() *The sleep study is based on a minimum of 2 hours of continuous recorded sleep or shorter periods of continuous recorded sleep if the total number of recorded events during that shorter period is at least the number of events that would have been required in a 2-hour period. Greater than 20 episodes of oxygen desaturation (i.e., oxygen saturation of less than 85 %) during a full night sleep study, or any one episode of oxygen desaturation (i.e., oxygen saturation of less than 70 %). Member's apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) is greater than or equal to 15 events/hour with a minimum of 30 events orĪHI or RDI greater than or equal to 5 and less than 15 events/hour with a minimum of 10 events and at least one of the following is met:ĭocumented hypertension (systolic blood pressure greater than 140 mm Hg and/or diastolic blood pressure greater than 90 mm Hg) orĭocumented symptoms of impaired cognition, mood disorders, or insomnia orĮxcessive daytime sleepiness (documented by either Epworth greater than 10 (see appendix)) or It is expected that members receive lifestyle advice where applicable (i.e., helping people to lose weight, stop smoking and/or decrease alcohol consumption).Īetna considers CPAP or autoPAP medically necessary DME for members with a positive facility-based NPSG*, or with a positive home sleep test* including Type II, III, IV(A) or Watch-PAT devices, as defined by either of the following criteria: Treatment of snoring alone, without significant OSA, is not considered medically necessary.Ĭontinuous Positive Airway Pressure (CPAP) Now Aetna's clinical bulletin states the following The lowest oxygen saturation was 82 %, and 0.8 % of the sleep time was spent at saturations below 90 %. Respiratory Analysis demonstrated 60 obstructive apneas and 26 hypopneas, with an APNEA HYPOPNEA INDEX (AHI) of 11.5. The patient estimated a total sleep time of 449.5 minutes. Now this sleep study came up with Mild Sleep Apnea diagnosis. I tried to go to the original DME (but with a different insurance carrier) who insisted I get a Sleep study done before getting a new machine since I had changed carriers, which I did. I was not using my machine since I couldn't stand it (I was in my 30's I thought I was invincible) But now I feel the pain in my chest in the morning getting worse so I decided to get a CPAP machine (my doc recommended ResMed S9 AutoSet). Contact us today at if you have any other questions.I have been diagnosed with OSA since 2007. We also offer private pay services if your insurance does not cover sessions for $145 per session. We will reach out to you personally to determine payment options for future sessions if you wish to continue working with your dietitian. It is risk-free to try Nourish, if your insurance denies payment or your claim goes to a deductible that you don't wish to contribute to, we will not charge you for any sessions that have already occurred. In these cases, you will be responsible for those fees. In some cases, there are costs associated with using insurance such as a copay or coinsurance. Use our insurance coverage calculator to verify your coverage and learn more about how we work with your insurance company. ![]() For in-network patients, we work with your insurance company to ensure coverage.ĩ4% of in-network patients pay $0 out of pocket. ![]() Nourish is currently in-network with 5 major insurance companies, Blue Cross Blue Shield/Anthem, United Healthcare, Aetna, Cigna, and Medicare. ![]()
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