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Health insurance for sleep apnoea

If you're a poor sleeper, you may have sleep apnoea. Here's how you can get cover for both overnight investigation and sleep apnoea.

Sleep apnoea is a serious sleep disorder that occurs when your breathing is frequently interrupted or stops when you sleep.

What are the symptoms of sleep apnoea?

While it is often hard to distinguish sleep apnoea from other sleeping problems, there are a few recognisable symptoms that you will feel consistently:

  • Waking up choking or gasping
  • Waking up with a sore or dry throat
  • Loud snoring
  • Sleepiness or lack of energy during the day
  • Headaches, especially in the morning
  • Forgetfulness and mood changes

Is there a sleep apnoea test?

In order to find out if you're suffering from sleep apnoea, you can get a sleep test. Doctors will monitor things like your heart rate, blood pressure and oxygen levels. Your doctor usually prescribes the tests, which involve you spending a night in hospital so you can be properly monitored.

How does Medicare cover sleep apnoea?

Before you can receive a Medicare rebate for a sleep study test, your doctor will need to make sure you are eligible by asking a series of approved screening questions. This is in order to make sure you definitely have a sleep disorder and are not being misdiagnosed.

Medicare may also cover Continuous Positive Airway Pressure (CPAP) therapy if you've been diagnosed with sleep apnoea. Your doctor will determine if you are eligible for CPAP based on how effective they feel the therapy may be in your situation.

Although Medicare will cover some of the costs, you will still have out-of-pocket expenses. These can add up each time you receive care.

Sleep apnoea is often difficult to diagnose and can be a long, time-consuming process with Medicare. Doctors can be reluctant to refer you for testing since treatment isn't always effective and is so time-consuming.

How does private health insurance cover sleep apnoea?

The majority of private health insurers will take you in for an overnight stay in hospital in order to assess you properly. You can get cover for this on a fairly basic policy. Others offer a free home sleep test before moving forward.

Treatment options vary depending on your insurer, but if your doctor recommends CPAP therapy, some offer a discounted trial period to see if your health and sleep improves. With certain insurers, you are also able to claim a benefit for the cost of purchasing a CPAP machine.

For alternative treatment, such as nasal surgery or a tonsillectomy, you may need more comprehensive cover.

As well as diagnosis and treatment, you get to choose your own doctor and hospital. This is important for a lot of people as diagnosis usually involves spending a night in hospital. Private insurance lets you choose the best possible facility.

While there will be some out-of-pocket expenses, cover can be very affordable. Make sure that when you're looking for hospital cover, you get sleep apnoea treatment and overnight investigation covered.

It's also worth remembering you should always get the Medicare Benefits Schedule (MBS) number from your doctor. This lets you know exactly what you'll pay, so you are able to budget well in advance of treatment.

Health Insurance Reforms coming April 2019

As part of the reforms to the Australian health insurance system, we will see hospital policies placed in four categories: gold, silver, bronze and basic.

Each of these tiers includes cover for a minimum number of clinical categories. If you wish to continue to claim benefits for sleep studies such as apnoea or snoring, you will need a policy of Gold tier.

What does sleep apnoea treatment involve?

Most commonly, you'll receive breathing apparatus, such as a continuous positive airway pressure machine (CPAP), which will assist your night-time breathing. This prevents you from snoring and, more importantly, makes sure you're breathing properly. It also helps ensure you're getting enough oxygen to your brain.

You may also receive weight loss and physical exercise help. Unhealthy lifestyles can contribute towards people getting sleep apnoea.

Depending on your cover and condition, you may also receive help from a respiratory therapist, otolaryngologist or pulmonologist. This can often involve taking medication – including sleep medication – and surgery in some cases.

Picture: Unsplash

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