Private payers put squeeze on sleep

‘They are trying to decrease sleep studies’
Friday, April 4, 2014

YARMOUTH, Maine – Since the first of the year, CPAP providers have seen an onslaught of policy changes among private insurers that have made it harder for them to do business.

“Every day, we hear of a new insurance company putting more restraints on getting services,” said Lisa Feierstein, president and co-founder of Raleigh, N.C.-based Active Healthcare. “It’s almost like the insurance companies want to limit access to care.”

One of the biggest changes: an increase in the use of prior authorizations for CPAP/supplies and sleep studies, whether it’s a full study in a sleep lab or a home sleep test, say providers.

“We happen to own two sleep labs and we’ve absolutely seen an increase in PAs,” said Ron Evans, owner of Phoenix-based Valley Respiratory Services. “Sixty percent are now requiring PAs and it used to be less than 10%.”

While prior authorizations are nothing new for full sleep studies, they’re new for home sleep testing. Traditionally, private insurers have seen the benefits of the technology—it’s patient preferred and less costly—and green-lighted these tests.

That’s been provider Erik Parkhill’s experience.

“I think probably 60% of the payers cover home sleep tests at 100%,” said Parkhill, vice president of HMP Diagnostics in Gainesville, Ga.

But as utilization for home sleep tests continues to rise, more private insurers will attempt to slow that growth, too, predicts Feierstein.

“The insurers are trying to decrease sleep studies,” she sad. “They are putting in lots of controls.”