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Sleep Apnea Claims: Getting Tested for Sleep Apnea

Sleep apnea is a common health problem that is characterized by interruptions in your breathing cycle while sleeping. Lack of a restful night can lead to headaches, stress, chronic fatigue and can increase your risk for a variety of health issues including diabetes and high blood pressure. If you experience frequent sleep disruptions such as loud frequent snoring or pauses in breathing it’s important to see a healthcare provider for a sleep apnea test.


The testing process is simple, painless and fast. It may take place overnight in your home or in a sleep lab facility depending on your health provider and insurance coverage. Most people don’t experience any discomfort during the test and fall asleep during the procedure. Adhesive sensors are placed on your body at the scalp, forehead, chin, chest, leg, and index finger to collect information from your brain, heart, lungs, and muscles. Bands may also be wrapped around your chest and stomach to measure your breathing. Data is gathered while you sleep.

Your doctor will review the information on your sleep patterns and work with you to develop the best treatment plan for your condition. There are lots of treatments for sleep apnea including special equipment and breathing machines that can help you to get a peaceful night’s sleep. The first step in a healthier life is getting tested.  


Most insurance companies will pay for a medical sleep study ordered by a provider. At Apex EDI, we’ll make it easy for you to pay your sleep apnea claim. We know a good night’s sleep is vital to your overall health. If you are interested in finding out more about these type of claims then contact us at Apex EDI today!

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

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Sleep Apnea Claims: How to Code and File a Sleep Apnea Claim Correctly

As the practice of wellness becomes a more congruous and cohesive effort between practices, many medical and wellness practices begin to file insurance claims that might normally be filed with a specialist.


One such claim is that of sleep apnea oral appliance therapy (OAT) devices. When filing for a patient to receive treatment for sleep apnea, it is important to file the claim correctly in order to ensure claim approval.


Prior to filing an OAT claim, it is important to get in touch with the patient’s medical insurance in order to verify eligibility and benefits. Questions that need to be asked include:

  • Is OAT covered by the plan?
  • Will a preauthorization be required?
  • What percentage will be paid?
  • What is the deductible, how much of the deductible has been met, and when does the new plan year begin (to determine if a new deductible will apply)?
  • What is the replacement time period?
  • Is a referral necessary from the primary care provider?
  • Do you require modifiers for the appliance?
  • What is the claim mailing address?

These questions verify which services, procedures and medical devices the patient is eligible to receive through their insurance provider. Verifying eligibility allows for your clinic to grab a better sense of which services the patient can have billed to insurance, and which will most likely be paid out of pocket.


Thorough SOAP note documentation is essential when filing a claim for sleep apnea. An example of SOAP notes for a sleep apnea case would be:

  • A detailed report of exactly what the patient is struggling with. Be sure to include diagnosis codes within the note to ensure proper coding and approval from the clearinghouse.
  • Examination findings including gender, height, weight, blood pressure and heart rate, etc.
  • An assessment of the findings that determines the cause of the symptoms.
  • A clear plan of treatment that includes the recommendation for an OAT device to treat sleep apnea.

The more detailed and clear the note is, the more likely the patient is to be approved for the OAT device for sleep apnea based on their current medical benefits. A lack of information or unclear SOAP notes does not provide an insurance company with enough valid information to approve a sleep apnea claim.

Sleep apnea claims that include proper billing and diagnoses codes, detailed SOAP notes, and verified eligibility allow for your practice to serve your patients needs more fully, and provide exceptional care.

For more information about the cross coding capabilities of Apex EDI for sleep apnea claims, be sure to sign up for more information here.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Sleep Apnea Claims

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