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Sleep Management Program

Blue Care Network’s medical policy on the diagnosis and management of obstructive sleep apnea was revised Sept. 1, 2009, to include coverage for home sleep studies for patients with no comorbid conditions. Effective July 1, 2009, clinical review is required for all sleep studies for BCN commercial and BCN Advantage members when the study is performed in an outpatient treatment setting (at home or in an outpatient facility or clinic).

Sleep study candidates include habitual snorers with daytime sleepiness or observed apnea (cessation of breathing lasting 10 seconds or more). Daytime sleepiness can be determined by using a common assessment tool available to health care providers, such as the Epworth Sleepiness Scale or the Stanford Sleepiness Scale.

Home sleep studies allow for testing in the comfort of the patient’s own bed and can be provided in rural areas where the nearest sleep center may be hours away or there are no available appointments for months. Home sleep studies are covered to diagnosis obstructive sleep apnea for patients who fit the following description:

BCN’s contracted provider for home sleep studies is Oximetry Company, LLC. Contact Oximetry at 1-877-622-2022. In addition to scheduling and interpreting the home sleep study, Oximetry offers compliance monitoring. A sleep technician will contact the patient at scheduled intervals to ensure proper instruction and compliance, and to answer questions regarding the therapy.

Outpatient facility or clinic-based sleep studies are also covered by BCN and are recommended if the patient is not a candidate for a home sleep study.

Sleep study authorization sample questionnaires
When requesting authorizations for sleep studies on e-referral, the system will prompt the submitter to complete a questionnaire to determine the appropriateness of the request. The questionnaire differs based on the treatment setting selected.

For more information