Insurance Guide
Understanding your insurance benefits
Welcome to The Sleep Clinic’s insurance guide for patients! We understand that navigating insurance can be a confusing and daunting task, but don’t worry, we are here to help. Our goal is to ensure that you receive the best possible care without any significant financial burden.
The information we receive may not always be the most accurate and updated benefit coverage. We strongly suggest our patients contact their insurance provider’s member services department before coming to see the doctor. It’s important to be clear on what your individual plan covers before your visit.
What you will need:
- Your insurance card. The phone number for member services should be on the back of the card.
- Policy holder’s name and date of birth.
- Your doctor’s name and office address.
What To Ask
1. To ensure you receive optimal coverage for your upcoming visit to The Sleep Clinic, we recommend you take the following steps:
2. Verify that The Sleep Clinic is included in your insurance plan’s network of providers.
3. Inquire about your coverage for the following services (not an exhaustive list)
- Consultation with a sleep doctor as a new patient (CPT Codes 99203, 99204, 99205)
- Polysomnography, diagnostic (CPT Code 95810)
- Home sleep apnea test (CPT Code 95806, 95800)
- Polysomnography with CPAP (CPT Code 95811)
Helpful Terms
- Network: the group of healthcare providers, facilities, and suppliers that have contracted with your insurance company to provide services.
- Premium: the amount you pay monthly or annually to keep your insurance coverage.
- Deductible: the amount you must pay out of pocket for covered services before your insurance starts paying. For example if your insurance plan has a $1000 deductible, you would be responsible for paying $1000 of your healthcare expenses before your insurance plan starts paying its share of covered services.
- Co-pay: one of the ways you share in your medical costs. It is a fixed amount you pay for a covered service, usually due at the time of service. For example, you may have to pay $10 for a doctor’s visit while your insurance company pays the rest.
- Coinsurance: a percentage of the cost you pay for a covered service after you’ve met your deductible. For example, if the insurance company pays 80% of the claim, you pay 20%.
- Out-of-pocket Maximum: the maximum amount you’ll have to pay out of pocket in a given year for covered services, including deductibles, copays, and coinsurance. This is the most money you will pay during a year for coverage – beyond this amount, the insurance company will pay all expenses for the remainder of the year.
- In-network Provider: a healthcare provider that has contracted with your insurance company to provide services at a discounted rate.
- Out-of-network Provider: a healthcare provider that does not have a contract with your insurance company, meaning you may have to pay more out of pocket for their services.
- Prior Authorization: a process that requires your healthcare provider to obtain approval from your insurance company before performing a specific procedure or service.
