[March 06, 2015]

Losing Sleep over More Than Just the Time Change

The springing forward of the clock isn't the only reason some people may be losing sleep. More and more Americans are being diagnosed with sleep disorders. Before the diagnosis, consumers face an eye-popping range of sleep test costs --$200 for in-home testing to $670 in an independent freestanding center to more than $2,300 in a hospital outpatient department.

"Consumers are getting more savvy about the quality and cost of their healthcare, especially with the growth in popularity of benefits with lower premiums but higher out-of-pocket payments," said Brian Griffin, president of Empire BlueCross BlueShield. "We recommend all consumers ask their doctors if they are candidates for in-home sleep testing and if not, they should ask questions about the costs of similar quality facilities - which range widely in price."

When Empire BlueCross BlueShield members receive an order to get a facility test at a specific center that is at least $300 higher than other similar accredited facilities in a 30-mile radius, AIM Specialty Health, which handles clinical management services for Empire, calls the member with information about these less expensive, accredited facilities and assists in scheduling an appointment if the member chooses.

"We have found an average difference in cost of $1,316 per facility test in New York," said Thomas Power, MD, AIM medical director for cardiology and sleep medicine. "When you consider that most members are paying about 20-25 percent on average out of their own pocket for these tests, just that difference in savings could have been used to pay for groceries, or make a monthly car payment or pay school tuition."

More than 12 million Americans suffer from sleep apnea and many are undiagnosed, according to the National Institutes of Health. It's a condition caused by the obstruction of the upper airway that results in repetitive pauses in breathing during sleep that can lead to daytime sleepiness or fatigue. Sleep apnea also increases health risks, such as cardiovascular disease, high blood pressure, stroke, diabetes, depression, weight gain and obesity.

The Harvrd Medical School Division of Sleep Medicine estimated in 2010 that the total annual economic cost of sleep apnea was $65-$165 billion - greater than asthma, heart failure, stroke and hypertensive disease. The numbers included costs to diagnose and treat the condition, with a much larger percentage of the costs derived from hidden health care costs related to its impact on other diseases and its role in motor vehicle accidents.

While a home-based test ordered by a physician is likely appropriate for 70-80 percent of patients with suspected sleep apnea, data show only about 25-30 percent of all sleep apnea testing takes place at home, according to a 2014 national analysis by AIM Specialty Health before the sleep program began. Doctors enter information about their patient into an AIM web service tool to determine whether an at-home test is appropriate for their patient. Today, 60 percent of those who are eligible in Empire plans, are getting their sleep test at home.

For those whose condition is more appropriate for facility testing, AIM will contact members and inform them of options for sleep testing sites that have met accreditation and certification guidelines and provide competitive prices.

"For members who have high-deductible plans or consumer-driven health plans, this program can be useful in helping them control the portion of their health care costs they pay directly," said Griffin. "The sleep management program is one of several programs we are putting in place to help members and employers reduce or maintain costs while still offering the same quality of services. We are hopeful that these kinds of programs can also help us in controlling the rise of insurance premiums."

About Empire BlueCross BlueShield

Serving New Yorkers for 80 years, Empire BlueCross BlueShield is the largest health insurer in New York supporting more than four million members and more than 38,000 business, union and small employers in New York. Empire BlueCross BlueShield (Empire) is the trade name of Empire HealthChoice Assurance, Inc., and Empire Blue Cross Blue Shield HMO is the trade name of Empire HealthChoice HMO, Inc., independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the 28 eastern and southeastern counties of New York State. Additional information about Empire is available at www.empireblue.com. Also, follow us on Twitter (News - Alert) at www.twitter.com/healthjoinin or @empirebcbs, on Facebook (News - Alert) at www.facebook.com/HealthJoinIn, or visit our YouTube (News - Alert) channel at www.youtube.com/healthjoinin.

About AIM Specialty Health

AIM Specialty Health_® is focused on driving appropriate, safe and affordable care through the healthcare system. For more than 40 million members covered across 50 states, D.C. and US territories, AIM targets the quality and cost of clinical services including radiology, cardiology, oncology, specialty drugs and sleep medicine. As a national leader in specialty benefits management, AIM helps health plans, providers and employers focus on the value of health decisions with an integrated suite of solutions combining clinical excellence, technology and superior customer service. For more information on AIM, please visit www.aimspecialtyhealth.com.

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