Coverage for CPAP

Sometimes a patient will have symptoms of obstructive sleep apnea but they don't meet their insurance company's strict criteria for coverage of a cpap machine. I wrote the following on the AASM discussion board, in response to another poster's suggestion of a dental appliance or the Pillar procedure:

Often oral appliances ($1400-1500) and pillar implants have to be paid for out of pocket. If a patient can afford this, they should be able to afford a cpap machine, even if there is no insurance coverage for it. Many payors will cover a cpap titration even if the patients don't meet criteria for coverage of a cpap machine. For example, if a medicare pt has a lot of hypopneas with less than 4% desat, I will call it OSA (327.23) if the pt has syxs and their is a lot of sleep fragmentation from the hypopneas. The cpap titration would be covered, but not the cpap machine. Medicare's strict criteria are for the coverage of a cpap machine, and not for the diagnosis of OSA itself. A cpap machine can usually be obtained for under the cost of a dental appliance.

There are additional options for the treatment of mild OSA. I often suggest the trio of avoiding sleeping in the supine position, weight loss, and a steroid nasal spray.
Some of my patients have found the Anti-Snore Shirt helpful.