Does Blue Cross Blue Shield Cover Sleep Apnea Treatment?

Does Blue Cross Blue Shield Cover Sleep Apnea Treatment?

Does Blue Cross Blue Shield Cover Sleep Apnea Treatment?

Yes. BlueCross BlueShield of Nebraska (BCBSNE) like most insurers recognizes that sleep apnea is a serious medical condition. If left untreated, the cost of related health conditions related to sleep apnea is much greater than the cost of treating sleep apnea. So BCBSNE covers the diagnosis and treatment of sleep apnea.

Here are more details about sleep apnea coverage from BCBSNE.This information is taken from public documents published by BlueCross BlueShield and is generally representative of their policies. However, BCBSNE notes that medical policies are specific to each member’s plan. During your consultation, we can talk about your specific coverage, or you can check here to read the actual policies of your plan.

Home Sleep Tests Preferred

One recent update from BCBSNE is that most adults with a suspicion of sleep apnea should use a home sleep study for their primary diagnosis of sleep apnea. A home sleep study must record a minimum of four channels (oxygen saturation, respiratory movement, airflow, and EKG/heart rate). In order to qualify for a home sleep study, you have to be free from:

  • Health conditions that decrease accuracy of sleep study, such as:
    • Congestive heart failure (CHF)
    • Hypo-ventilation syndrome
    • Moderate to severe lung disease
    • Neuromuscular disease
  • Suspicion of other sleep disorders, such as:
    • Central or complex sleep apnea
    • Narcolepsy
    • Sleepwalking, night terrors, and other parasomnias
    • Periodic limb movement disorder

In addition, you might be required to have a supervised overnight sleep study polysomnogram (PSG) if:

  • Your home sleep study didn’t work
  • Your home sleep study didn’t show sleep apnea, but your doctor strongly suspects the condition

Whether you have a home sleep study or a laboratory PSG, a home sleep study may be recommended to make sure your treatment is working.

BCBS Wants You to Try Lifestyle Modification

Alongside treatment with oral appliances or CPAP, BCBSNE may recommend that you attempt to reduce your sleep apnea or cure it with lifestyle modification.

Some of the recommended modifications include weight loss, allowing yourself enough time for sleep, side sleeping, quitting smoking with a supervised program, and avoidance of alcohol, caffeine, and sedatives before bedtime. These are not considered standalone treatments, but they are recommended as supplemental treatments that may be recommended when appropriate.

When Oral Appliances Are Covered

If you’ve been diagnosed with sleep apnea, an oral appliance is considered a frontline treatment for many types of sleep apnea, and is also considered a backup therapy for CPAP in other cases.

Oral appliances are covered when you have:

  • Moderate or severe sleep apnea (apnea/hypopnea index (AHI) 15 or greater)
  • Mild sleep apnea (AHI 5-15) accompanied by sleep apnea symptoms like:
    • Excessive daytime sleepiness
    • Difficulty thinking
    • Mood disorders
    • Insomnia
    • High blood pressure
    • Ischemic heart disease
    • History of stroke

Your doctor may recommend CPAP, but you have the right to refuse it and choose oral appliance therapy. In addition, you have to meet the following requirements:

  • Sleep apnea diagnosis with home sleep test or lab PSG
  • The device is prescribed by your doctor
  • The device is custom-fitted by qualified dental personnel
  • You don’t have TMJ or gum disease

If you meet all these criteria, your oral appliance should be covered by BCBSNE.

When CPAP Is Covered

In order for BCBSNE to cover your CPAP, you need to have diagnosed sleep apnea with a home sleep study or lab PSG. CPAP is covered for mild or moderate sleep apnea that meets the conditions above, and in all cases of severe sleep apnea. In addition:

  • Auto-adjusting positive airway pressure (APAP) might be used for two weeks to help find the right pressure for sleep apnea patients
  • CPAP might be considered necessary for central sleep apnea or complex sleep apnea

In general, it’s expected that you’ll have a CPAP titration session, which is typically a supervised lab study. During this study, you’ll get the pressure adjusted to make sure it’s right.

What’s a Good Faith Effort at CPAP?

It’s understood that many people don’t tolerate CPAP. However, BCBSNE requires that you make a good faith effort at CPAP when prescribed before it’s considered failed. In order for it to be considered failed, you have to start with a proper pressure titration, and then you have to work with your doctor to try to make CPAP tolerable.

Techniques recommended to improve tolerance of CPAP may include:

  • Emotional support
  • Alternate mask fitting for effect and comfort
  • Nasal pillows
  • Humidification
  • Ramping of CPAP pressure

For people with special psychological factors–such as “anxiety, “unfamiliarity,” or “other non-physical reasons”–that may make CPAP difficult, multiple titrations may be recommended. It’s also recommended that you try CPAP for a minimum of two months before giving up.

Are You Looking for Sleep Apnea Treatment in Omaha?

If you’ve been diagnosed with sleep apnea and would like to try oral appliance therapy in Omaha, we can help. We accept BCBSNE and most other types of insurance.

To learn how we can help you with comfortable, convenient sleep apnea treatment, please call (402) 493-4175 today for an appointment with a sleep dentist at the Advanced Dental Sleep Treatment Center.