What this will cost you

How we handle it

We cannot publish your price. It depends on your plan, your deductible, and which test or treatment is ordered, and anyone who quotes you a figure from a website without seeing your plan is guessing.

What we can commit to is the process. Before anything is scheduled, the office checks your benefits and tells you what your plan is likely to require. If prior authorisation is needed, we tell you before the appointment rather than after the bill.

This practice accepts Medicare assignment.

Plans this practice has historically worked with

• UnitedHealthcare
• Cigna
• Buckeye Health Plan
• Anthem Blue Cross Blue Shield
• Aetna
• UMR
• TRICARE
• Medicare
• Medical Mutual
• MediGold
• Oscar
• OhioHealth
• Luminare Health

If your plan is not on this list, ring anyway. The list reflects what we can currently evidence, not the limit of what we can check for you.

Do you need a referral?

It depends on your plan type rather than on us. As a general pattern, PPO products usually let you refer yourself to a specialist, while HMO and Medicaid managed-care products often require your primary care doctor to send you, and seeing a specialist without that can leave you with the bill.

Two specifics we can evidence. Ohio Medicaid managed-care members are assigned a primary care physician who provides specialist referrals, and going outside that route can shift cost onto you. And for plans inside Cigna’s sleep management programme, outpatient diagnostic sleep studies require precertification through EviCore.

What a sleep study costs

For scale rather than as a quotation, these are the 2025 Medicare national allowed amounts. They are what Medicare allows, not what this practice charges and not what you will be billed.

Under Medicare Part B you would generally pay 20 per cent of the allowed amount after your deductible, where the study is medically necessary. Commercial plans frequently require prior authorisation for both in-lab and home studies.

What treatment costs

Positive airway pressure equipment is supplied through a durable medical equipment provider and billed separately from us. Most plans copy Medicare’s rule and require documented use of at least four hours a night on 70 per cent of nights, within a 30-day window in the first 90 days, to continue covering it.

For implanted stimulation, prior authorisation is the rule rather than the exception, and the coverage criteria are stricter than the FDA labelling. That is set out on the Inspire therapy page.

For medication, Medicare Part D excludes drugs used for weight loss. The sleep apnea indication for tirzepatide is a separate labelled use that some Part D formularies may cover with prior authorisation, plan by plan. There is no national Medicare coverage of it.

What to ask your plan

If you want to get ahead of it before you ring us, these are the questions that actually determine your cost:

• Do I need a referral from my primary care doctor to see a sleep physician?
• Is prior authorisation required for a sleep study, and for which type?
• What is my deductible, and how much of it have I met?
• Is the sleep laboratory in network?
• Which durable medical equipment suppliers are in network for CPAP?

Sources

1. Medicare coverage of sleep studies. https://www.medicare.gov/coverage/sleep-studies
2. AASM 2024–2025 sleep payment and RVU comparison. https://aasm.org/wp-content/uploads/2024/11/sleep-payment-RVU-comparison-2024-2025.pdf
3. Cigna sleep services precertification quick reference guide, EviCore. https://www.evicore.com/sites/default/files/resources/2025-10/Cigna%20Precertification%20Services%20Sleep%20-%20QRG_10-20-2025.pdf
4. UnitedHealthcare Community Plan of Ohio member handbook. https://hmn.uhc.com/communityplan/assets/plandocuments/handbook/en/OH-Medicaid-Handbook-EN.pdf
5. Buckeye Health Plan prior authorisations. https://www.buckeyehealthplan.com/members/medicaid/benefits-services/prior-authorizations.html

Related pages

• Sleep testing →
• Request an appointment →
• Contact and directions →