Sleep Disorders and Health Insurance

Maybe it’s the economy, but Americans are having an increasingly difficult time falling asleep and staying asleep. The U.S. Institute of Health estimates that 30 million of us suffer from insomnia, another 6 million have moderate to severe sleep apnea and another 6 million have periodic limb movements that wake them up repeatedly throughout the night. Interrupted sleep does more than leave you tired and cranky the next day. It can lead to serious health problems like depression and a compromised immune system. Chronic sleep deprivation has also been linked to weight gain and high blood pressure.

Sleep Disorders and Health Insurance

If you’re tired of sleepless nights, many treatment options are available. But will health insurance cover sleep disorders? As with all things insurance, it depends. If you’ve been diagnosed with sleep apnea, insurance will cover your CPAP machine. Your insurance will probably cover replacement of the machine’s tubes, pads, masks and accessories twice a year, too. If you can’t tolerate the CPAP, insurance will usually pay for the more expensive BiPAP apperatus. If surgery is required, you’ll need to document your sleep apnea score and a log of time you’ve spent on a CPAP before the most insurers will authorize a procedure.

If you have prescription coverage in your health care plan, your prescription medication for a sleep disorder will probably be covered, but the amount of coverage will depend on the type of drug you’re taking and whether it’s name brand or generic. Your insurer may, however, consider medication as a short-term therapy and cut coverage after a few months. In that case, if you’re still having problems sleeping, you may want to have your doctor prescribe behavioral therapy.

It’s only been a few years since insurance company began covering the cost of sleep studies and cognitive-behavioral therapy. Some still don’t or they group sleep disorder with mental health benefits. Others will
require that you pay out of pocket and then will reimburse you for all or part of the charges. In any case, you’ll still need a doctor’s referral.

Increasingly, insurance companies are recognizing treatment for sleep disorders as a form of preventive care that avoids more costly health problems down the road.