Insurance & Billing

Frequently Asked Questions: 

 How am I billed for a sleep study?
When you have completed a sleep study, and the interpretation is completed by the MD, your insurance is billed. Processing by the insurance company can take up to 30 days to complete. You will receive an “Explanation of Benefits” (EOB) statement from your insurance company showing what was paid to BSWC for performing your overnight sleep study. The patient is responsible for paying any applicable deductibles, and co-insurance (patient portion) as agreed upon between you and your insurance. We will make arrangements for you to pay for your copay, co-insurance or deductible prior to your study. Payment is expected at time services are rendered.
 
Will I have to pay for a facility fee?
NO, you will not be charged for a separate facility fee. Some Hospitals charge up to $500.00 for having a sleep study done within their facility. However, at the Baltimore Sleep and Wellness Center we do not have such facility charges.
 
How does health insurance cover the charges for a sleep study?
Every health plan has a different amount that they agree to pay for a sleep study. Please familiarize yourself with your insurance plan, and be aware of any deductibles that have not been met. Generally speaking, the insurance will pay a portion of the billed charges or the “allowable amount”. This “allowable amount” varies from plan to plan. As a courtesy, the difference between what is billed to your insurance and the “allowable amount” is adjusted off your bill. You will be responsible for the patient portion of the allowable amount, which again varies from plan to plan. (BSWC Billed Charges) - (Allowable Amount) = “Adjustment” Amount (Allowable Amount)- (Insurance Payment Amount) = Patient portion due
 
What health insurance plans have an “in- network provider agreement” with BSWC?
(The following list reflects current contracts; these may change at any time. Please contact the office immediately if you have a change of insurance or demographics)
  • Aetna
  • Amerigroup
  • Beech Street PPO
  • Blue Shield PPO
  • Blue Choice
  • MedStar
  • Cigna PPO
  • Great West Healthcare of California
  • Humana ChoiceCare Network
  • Interplan Health Group
  • Medicare
  • Tricare
  • United Healthcare
  • ETC….
Please contact our office for a more up to date and complete list of insurance we accept.
 
What do I do if BSWC is not contracted with my insurance?
If your plan does not have an “in-network” contract agreement with BSWC, your co- insurance (patient portion) may be different. Please contact your insurance plan for the out-of network amounts. As a courtesy, we try to minimize the difference between what you may pay “out of network” vs. “in network”. Our biller can also assist you in this process.
 
Are there any other payment options?
Cash discount: If you would like to pay cash for your sleep study, a cash discount is offered and is equal to 110% of current Medicare rates. Please call the office with questions.

Financial options: If you are unable to pay all at once, we do accept VISA, MC, AMEX and DISCOVER.
 
Who can assist me with my insurance at BSWC, and what are the billing codes used for a sleep study?
Our experienced insurance billing specialist, Stacey, can be contacted at the office at (410)576-8950 for questions regarding payment for your sleep study. Please also call your insurance company for specifics regarding your plan.

Codes used:

  • Overnight Diagnostic Sleep Study (Polysomnogram-Diagnostic): 95810
  • Overnight Therapeutic/ Titration Sleep Study (Polysomnogram-Titration): 95811
  • Multiple Sleep Latency Test (MSLT) or Mean Wakefulness testing(MWT): 95805
  • Home Sleep testing : Medicare G0400, non Medicare 95806
  • PAP/NAP: 95807
  • Actigraphy
  • Nocturnal Pulse Oximetry
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