Did you know that if you don't use all of your health insurance benefits this year, you lose them forever? 

You may have met your deductible for 2016 already. If so, you can take advantage of lower (or no) out-of-pocket expenses for medical services such as sleep studies, PAP or supplies (learn about insurance coverage for these services here).

Waiting until next year means that not only will you lose any unused benefits for this year, but also that you'll have to first satisfy a new year's deductible before any benefits will be paid. 

We understand that patients and their physicians are concerned about rising out-of-pocket expenses for health care; unfortunately, this often affects decisions about how healthcare is administered.

Now, more than ever, it's important to understand your insurance benefits and take advantage of your benefits. Here are some key terms that you should understand.

The patient clearly has sleep apnea, but it's not severe enough for the insurance company to cover therapy. Why?

Unfortunately, there are varying opinions about how sleep apnea is diagnosed and when CPAP is the appropriate therapy.

Primarily, the difference is between how Medicare (CMS) and the American Academy of Sleep Medicine (AASM) define a diagnosis of sleep apnea. And many commercial insurances are starting to follow Medicare's guidelines for CPAP coverage.

In this post we'll explain what insurance companies, including Medicare, are looking for in a sleep study to determine coverage for CPAP. We'll offer suggestions of what to do if insurance won't cover CPAP.

Sleep apnea affects more than 20 million Americans, yet most are undiagnosed and untreated.

A sleep study, whether performed at-home or in a sleep center, is the most effective way to diagnose many sleep disorders, like sleep apnea.

Learn about the typical requirements for ordering sleep studies.

Telemedicine was a hot topic at this year's Sleep conference, a joint meeting of the American Academy of Sleep Medicine and the Sleep Research Society, in Denver, Colorado.

Telemedicine has been embraced by primary care physicians in rural areas who struggle to arrange for specialist consultations for their patients who have limited access due to the cost or convenience of traveling to the major cities where these specialists usually reside.

If telemedicine can increase access to specialists, can it help the millions of undiagnosed Americans suffering with sleep apnea and other sleep disorders?

1. You don't have health insurance.

This is a no-brainer. If you don't have health insurance, but have sleep apnea, you will need to pay cash for your machine and supplies. 

If you're having a hard time making ends meet, check out the organizations listed in this post that offer free or low-cost CPAP and supplies.

2. You have a high deductible health plan.

Many Americans now have higher deductibles to meet before their health insurance benefits kick in (check out our guide for understanding your health insurance here). While we understand that having a higher deductible usually means lower monthly premiums and that some benefits, like preventative care, are covered before you meet your deductible, almost all plans require you meet your entire individual or family deductible before CPAP and supplies, or sleep studies, are covered. Especially at the beginning of the year, this can mean paying entirely out of pocket for your new CPAP and supplies.

Even if you have insurance, you may prefer to shop online and pay cash for CPAP and supplies. While most online suppliers will not bill your health insurance (most of them aren't contracted with any insurances at all) some will and many will provide you with a list of codes so that you can submit the bill to your insurance. While you won't receive anything back from your insurance, you will receive "credit" towards your deductible. Especially if you or another family members expects to use your insurance throughout the year, you want to make sure every dollar you spend out of pocket is counted towards your deductible (learn about in-network vs. out-of-network deductibles and coverage differences here).

You should also consider using your HSA (health savings account) or FSA (flexible spending account) funds to pay for CPAP and supplies online. Save your receipts!

Are you enrolled in Medicare or have patients who are?

Learn about Medicare Part B coverage for sleep studies (Part B covers certain doctor's services, out patient care, medical supplies and preventative services).

Does Medicare cover in-home sleep apnea testing?

Yes.

In 2008, the Centers for Medicare and Medicaid Services (CMS) updated the National Coverage Determination for CPAP to include home sleep apnea testing (HST) as a means to qualify patients with obstructive sleep apnea (learn more about OSA here) for CPAP therapy (learn more about CPAP here).

If you have a diagnosis of sleep apnea, your insurance company will probably cover the cost of your CPAP or bi-level PAP device; however, coverage varies from plan to plan and so do authorization requirements.

Read more about insurance coverage below. We'll answer the basic questions, like what will I have to pay?, rental vs. purchase and some of the more technical questions, like what are the codes?

Out-of-network services: a nasty surprise ($150 vs $1,200)

A study from the Kaiser Family Foundation of Americans who had trouble paying their medical bills found that 32% received care from an out-of-network provider that insurance wouldn't fully cover and 21% of respondents did not know that their provider was out of network. 

Why is it important to choose an in-network provider?

If you've received a new PAP device to treat your sleep apnea in the past 12-18 months, you likely have a device that can be enabled to wireless transmit your usage data to your smartphone, your physician, your medical equipment provider and even your health insurance company.

Why? How? What does this mean for patients and their privacy? What are the benefits for patients and their healthcare providers?

The Affordable Care Act (also known as ObamaCare) rolled out in 2014. Since then, we've seen changes in how healthcare is administered by many insurance companies.

Here's an overview of how sleep apnea testing in-center and in-home, PAP therapy and oral appliance therapy are affected by the Affordable Care Act.