Insurance covers diagnosis, treatment of most sleep problems

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The diagnosis and treatment of sleep disorders have come a long way in recent years. In the past, people who snored might be advised to sew a tennis ball onto the back of their pajama top. The "snore ball" would discourage them from sleeping on their back and might quiet their droning. Or a doctor might use the "dog index" to measure poor sleep: If your dog generally sleeps with you but by morning has left the bed more than half the time, it may be because you're such a loud, restless sleeper that the dog has gone elsewhere for some peace and quiet.

How things have changed. Now, doctors with special training diagnose and treat more than 80 sleep disorders -- from obstructive sleep apnea to narcolepsy -- at special centers with labs where a patient's every sleeping moment may be recorded and measured.Insurance usually covers the diagnosis and treatment of sleep problems, with some exceptions. For example, snoring on its own is not a medical problem and insurance won't cover its treatment, to the great disappointment of many a snorer's bed partner.

Obstructive sleep apnea, which occurs in at least 2 to 4 percent of Americans is another matter entirely. The consequences of untreated sleep apnea can be extremely serious.

Sleep apnea is an obstruction of your airway that's created when the muscles at the back of your throat relax during sleep. The obstruction partially or completely stops your breathing, sometimes for a minute or longer, until your brain alerts your body to wake up and you start to breathe again. This can lead to fragmented, poor sleep as well as reduced oxygen levels, which can worsen such medical conditions ashigh blood pressure and diabetes and increase your risk ofheart attack and stroke.

As awareness of the problem has increased, so has demand for testing and treatment. Patients with suspected sleep apnea are typically sent to sleep centers where they are evaluated overnight while they sleep. In the past 10 years, the number of accredited sleep centers has grown from 566 to 2,258, according to the American Academy of Sleep Medicine.

Snoring is a common symptom of sleep apnea, but some experts say sleep studies may be overprescribed. "Everybody who snores doesn't need a sleep test," says Fred Holt, an ear, nose and throat surgeon in Raleigh, N.C., and an expert on sleep apnea who consults on anti-fraud issues for attorneys, medical auditors and investigators. The risk of developing sleep apnea is higher in people who are overweight, male, middle-aged or older, or smokers.

Medicare payments for sleep lab testing have increased from $62 million in 2001 to $235 million in 2009, according to the Department of Health and Human Services' Office of the Inspector General, which is conducting a study to review the appropriateness of Medicare payments for them. The study is due next year.

There are home sleep tests for problem sleepers as well, and their use is also on the rise, say experts. Rather than measure more than a dozen body functions while a person spends the night in a sleep lab hooked up to sensors, home sleep tests measure only a few functions while patients sleep in their own beds. Their cost is a few hundred dollars vs. up to $2,000 for a night in the lab.

Insurance will generally cover either type of test if it is prescribed by a physician. But while home sleep tests may mean a smaller bite out of your wallet if you have a co-payment or a high-deductible plan, they're not the best choice for everyone, sleep experts agree. "Home sleep testing should be reserved for people that are at high risk for sleep apnea and who don't have a lot of other illnesses likeobesity or heart disease that might alter the sensitivity of the test," says Nancy Collop, director of the Emory Sleep Center in Atlanta and president of the American Academy of Sleep Medicine.

Eli Walker snores and sometimes stops breathing for short times while sleeping. Walker, 63, read that there was a correlation between high blood pressure, for which he took two medications already, and sleep apnea. He went to see an ear, nose and throat specialist who sent him to a sleep lab near his Silver Spring home. Diagnosis: moderate sleep apnea.

Walker was prescribed a continuous positive airway pressure mask, which straps onto a person's face and directs pressurized air into the airway, keeping it open. But after three months of trying to use it, he gave up. "I hated it," he says. "I couldn't breathe naturally, and I didn't like the air blowing in my nose."

Walker finally found a good night's sleep with a specially fitted oral appliance that looks kind of like a sports mouth guard. The appliance, which must be fitted by a dentist with special training in sleep medicine, repositions and stabilizes the lower jaw and soft tissues so that the airways stay open. It typically works best with people with mild to moderate sleep apnea.

Good news for seniors: Private insurers have covered the dental appliances for years, according to Sheri Katz, president of the American Academy of Dental Sleep Medicine. In January, Medicare began covering them, too.

Auto Insurance Canceled After Cracked Windshields

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CHARLOTTE, N.C. -- The next time you file a claim for a cracked windshield, it could result in your auto insurance being canceled.
A State Farm customer for several years, Charles Stanford said his car insurance cancellation notice came out of the blue."I never in my wildest dreams thought that I would be dropped for something like that. It doesn't make sense to me,” Stanford said.He said the reason State Farm dropped coverage was a cracked windshield, which actually happened twice in the same month.He said the windshield replacement company chosen by State Farm replaced the glass both times.Stanford said the minor incidents were not his fault and his driving record is clean."(I) don’t have any speeding tickets, no parking tickets, no accidents.

I have absolutely nothing. Why in the world would you cancel me?" he said.Action 9 talked with insurance experts who said it’s rare for most companies to cancel coverage over cracked windshields.These cases, when compared to most minor fender benders, are a modest cost and a freak event and the driver should not responsible."Normally in a case like this they would raise your premium. That woulseem the logical thing to do, but here they've gone to the extreme and dropped them as a client," one expert said.Our sister station in Orlando, WFTV,contacted State Farm, which said “whether a driver is at fault is not the reason for some cancellations.”The company said its underwriting policy includes not renewing customers who have frequent claims within the same year and a family car had a cracked windshield in 2009.

According to Stanford, other companies have offered coverage, some at higher premiums. But no one turned him down over cracked windshield claims."If this is a common thing, the public needs to know about it," Stanford said.

All or nothing for some Allstate customers

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RALEIGH (WTVD) -- Some North Carolina residents say they are concerned, after a major insurance company is threatening to cut them loose.

More than 40,000 Allstate customers have been getting letters in the mail letting them know their homeowner's insurance policies will not be renewed unless they add on auto insurance.
Allstate Customer Ricky Stout says he pays his homeowner's policy each year. He says in all the years he's had Allstate, he never even filed a claim.
"I was very upset because all of a sudden now they are telling me I have to put my auto insurance with them or my homeowner's policy is gone I don't think it's right at all," Stout said.
Stout says he has his auto insurance through another carrier and is happy with it and does not want to make the switch.

"I don't think they're trying to keep me," he said. "I don't think they care."
Stout says he wonders why Allstate is taking this action and if it is even allowed.
ABC11 Eyewitness New I-Team Troubleshooter Diane Wilson reached out to Allstate and a representative says they will not offer the option to renew to about 44,700 North Carolina customers who only have property coverage and not an auto policy.

"More than 400,000 North Carolina customers have purchased insurance products from Allstate, and Allstate takes that responsibility very seriously," said John Heid, Allstate Senior Communications Consultant in the Southeast Region. "Managing our exposure is necessary to allow Allstate to continue to help provide protection and peace of mind through a variety of insurance products."
"At the same time, Allstate proactively seeks out solutions to meet the challenges posed by North Carolina’s insurance market, and to help preserve affordable access to insurance in this state."
"Allstate has made an agreement with Universal North America Insurance Company (Universal). As a part of our agreement with Universal North America Insurance Company, and in an effort to manage our overall risk in the North Carolina property insurance market, Allstate will not offer the option to renew for a segment of North Carolina property customers, most of which will be provided a quote for property coverage with Universal. Beginning with policies that renew on or after June 19, 2011, Allstate will not offer the option to renew to approximately 44,700 homeowner, Landlord’s Package Policy (LPP) and mobile home policies throughout North Carolina that did not also have an active standard Allstate auto policy as of December 15, 2010. The majority of these affected customers will receive a quote from Universal for property insurance coverage."
"These actions were carefully considered, and will help ensure Allstate’s continued ability to provide a wide variety of insurance products to North Carolina consumers at a competitive rate, while remaining financially strong in every community we serve."

A check with the state's department of insurance says Allstate's action is legal, as long asthe company gives the insured 30 days advanced notice of non-renewal.
Stout says he received that notice, but does not understand why Allstate wants to lose his $2,800 homeowner's policy each year.
"I don't understand as my homeowner's insurance is a lot more expensive than my car insurance and I'm like why are they worried about that little bit business," he said.