Does Aetna insurance cover obstructive sleep apnea (OSA) treatment for adults in NYC & NJ? The short answer here is Yes. Sleep apnea is covered by Aetna. However, some insurance plans and policies have different rules regarding treatment.
Learn more about Aetna health insurance coverage for obstructive sleep apnea for adult patients in NYC & NJ by contacting the office of Double Board certified surgeon Dr. Monica Tadros, M.D., F.A.C.S. Our office appreciates that understanding your own insurance benefits may seem overwhelming as we will work with you to verify your benefits and determine any financial responsibility you may have, such as deductibles or co-payments.
To be diagnosed with sleep apnea, a patient must undergo a preliminary examination from a primary care physician in NYC & NJ. If the physician suspects sleep apnea, he or she will refer the patient to a specialist for a sleep study. The results of the study will determine the diagnosis and treatment.
Aetna's Health Insurance Policy for Obstructive Sleep Apnea in Adults
[porto_blockquote]Aetna considers the diagnosis and treatment of obstructive sleep apnea (OSA) in adults aged 18 and older medically necessary according to the criteria outlined below.
- DiagnosisAetna considers attended full-channel nocturnal polysomnography (NPSG) (Type I device) performed in a healthcare facility medically necessary for diagnosis in members with symptoms suggestive of obstructive sleep apnea (see appendix), when attended NPSG is used as part of a comprehensive sleep evaluation, and member has one or more of the following indications for attended NPSG:
- Member has at least one of the following comorbid medical conditions that degrade the accuracy of portable monitoring:
- moderate to severe pulmonary disease (for example, COPD or ashma) (with nocturnal oxygen use or daytime hypercapnea with documented arterial blood gasses showing pO2 less than 60 or pCO2 greater than 45),
- neuromuscular disease (e.g., Parkinson’s disease, spina bifida, myotonic dystrophy, amyotrophic lateral sclerosis),
- stroke with residual respiratory effects,
- epilepsy,
- congestive heart failure (NYHA class III or IV or LVEF less than 45%),
- super obesity (BMI greater than 45, or pulmonary function studies show obesity hypoventilation syndrome (BMI greater than 35 plus arterial blood gas with PCO2 greater than 45, or BMI greater than 35 plus inability to lie flat in bed)); or
- Member has one or more of the following comorbid sleep disorders:
- periodic limb movement disorder (involuntary, jerking movements of the legs during sleep causing excessive daytime sleepiness (EDS) due to sleep fragmentation),
- parasomnias that are unusual or atypical because of the individual’s age at onset, the time, duration or frequency of occurrence of the behavior including, but not limited to: nocturnal seizures, psychogenic dissociative states, REM sleep behavior disorder, sleep talking and/or confusional arousals,
- narcolepsy,
- central sleep apnea or complex sleep apnea
- Member has at least one of the following comorbid medical conditions that degrade the accuracy of portable monitoring:
Source: Aetna
Although the cost of diagnosing and treating obstructive sleep apnea in NYC & NJ can be high, the long-term costs of not treating it are even higher. Dr. Monica Tadros can help you determine the best and most affordable form of treatment for your sleep apnea and other sleep disorders in NYC & NJ.
Request your no-obligation sleep apnea consultation in NYC & NJ with Dr. Monica Tadros today.
You may also call our office to speak to one of our Patient Advisors at (201) 408-5430.