A Good Night’s Sleep is Worth How Much?
It’s no secret we all feel better after a good night’s sleep. Unfortunately, according to the American Sleep Association, more than 50 million US adults have a sleep disorder. Sleep disorders are defined as problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Sleep deprivation is a real health concern.
“Sleep helps your brain function properly. Not getting enough sleep or poor-quality sleep has many potential consequences. The most obvious concerns are fatigue and decreased energy, irritability and problems focusing. The ability to make decisions and your mood can also be affected. Sleep problems often coexist with symptoms of depression or anxiety. Sleep problems can exacerbate depression or anxiety, and depression or anxiety can lead to sleep problems. Lack of sleep and too much sleep are linked to many chronic health problems, such as heart disease and diabetes.” American Psychiatric Association
As you can see, a solid night of sleep is worth a lot for overall health and safety. Sleep studies have been conducted by professionals in the U.S. since the 1920’s and are invaluable in the proper diagnosis of sleep disorders. Sleep research has even grown to involve many other medical fields of study, including neurology and cardiology. However, there is a cost to these studies and often this cost is way out of bounds.
Lost Night’s Sleep Equals Lost Benjamins
For example, let’s look at this month’s Lost Benjamins nominees. We identified two different claims involving polysomnography (sleep study) procedure codes for a self-insured client. The average cost of these procedures ranges anywhere from $1,000 to $4,000 dollars. However, the claims in these cases came in just under $30,000 each. That sure is a high cost for counting sheep!
In these instances, the TPA allowed the claims to be paid at full billed charges simply because a non-network provider performed the services. The TPA seems to have been “asleep at the wheel” by not recognizing these charges as unreasonable and questioning the claims with the provider. The charges were clearly excessive based on industry benchmarks.
After our discovery, we recommended that our client revisit the maximum allowed amount process with the TPA. There were alternative pricing methodologies to consider, such as an out-of-network fee schedule or limits as a percentage of Medicare.
Sleep disorders are increasing in our population and treatments need to be readily available. However, paying up to 10 times the normal charges for a sleep study is just absurd.
Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through its 100% Difference model, recovering millions of dollars for clients’ bottom lines with uncompromising ethics and accuracy. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for the world’s largest self-insured employers, involving all national payers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for employers.