We commonly see, "I need a sleep study for insurance," on the home sleep apnea test order forms that we receive. What is behind this seemingly unusual request from your life insurance company?
Sleep Studies for Life Insurance
After becoming a first-time dad a few years ago, I thought it would be prudent to get life insurance. During the quote process, I was surprised to get asked the following series of questions from the agent:
- Do you hang glide?
- Do you skydive?
- Do you have sleep apnea?”
Wow, sleep apnea lumped into the same category as these extreme sports? This is because the actuaries who work for the insurance companies are experts at calculating risk and know the increased mortality rate associated with sleep apnea. Medical research has shown an increased risk for sudden cardiac death in patients that have obstructive sleep apnea (OSA) with an abnormal breathing index (AHI) of >20 as well as a low average oxygen level (<93%) and the lowest oxygen level of <78%. If you have untreated sleep apnea that meets one of these criteria, you can expect that your life insurance rates will go up.
I have had a number of patients whose primary motivation for having a sleep study was an insurance requirement. If you meet certain biometric requirements, like an elevated body mass index or large neck size, or have one of several medical conditions like difficult-to-control high blood pressure that are highly associated with OSA, you might be asked by the insurance company to have a sleep study to evaluate for sleep apnea.
The Good News
Generally, if you have sleep apnea and can show that you've effectively treated it, your life insurance rates shouldn't be impacted. Insurance companies typically want you on CPAP, which is considered the gold standard treatment and the only therapy that allows compliance and efficacy to be measured and monitored on an ongoing basis.
What to Do If You Need A Sleep Study for Insurance
These days you have two options: in-lab sleep studies and home sleep studies. Home sleep studies have been found to be as accurate as in-lab sleep studies for the determination of OSA in at-risk patients. Home sleep tests, or HSTs (sometimes HSATs for "home sleep apnea test"), are more convenient and less costly. Before ordering an HST, confirm with the insurance company that they do not require an in-lab study; most don't.
If you do test positive for sleep apnea, insurance companies will need you to show "compliance" with CPAP use - this is generally defined as at least four hours of CPAP usage per day and hitting that mark on at least 70% of the nights in a thirty-day period. Please note: the medical science shows that the maximum health benefits of CPAP begin at a minimum of six hours of nightly usage.
Most new CPAP machines will allow your sleep doctor to obtain the usage data remotely. You will then need to sign a release to have this data, usually called a "compliance report" or "download," sent to your insurer.
I Think I Might Have Sleep Apnea but I Don't Want Insurance Companies to Find Out About It. What Are My Options?
If you go through your healthcare insurance company to obtain a sleep study, the report will become a part of your permanent medical record. When you apply for life insurance, you will need to sign a release so that your healthcare providers can send the insurance company your complete medical records. If you want to avoid this scenario, I suggest that you pay cash for a sleep study and do not authorize your results to go to your personal physician. Should you test positive for sleep apnea, you will have to pay cash for treatment as well if you want to "stay off the grid." You'll have to consider the cost/benefit ratio to this approach. The majority of patients who choose Singular Sleep for their sleep apnea management pay about $1500 total from testing to treatment with a premium CPAP machine and quality mask.
What about Health Insurance?
"Obamacare" led to a shift in healthcare premium calculations since insurance companies were no longer able to charge higher rates based on "pre-existing conditions." However, Obamacare was defanged when the individual mandate was repealed on January 1, 2019. There is now a major challenge to Obamacare in the courts and, eventually, it seems likely that it will either be overturned or continuously chipped away at to the point that it is irrelevant. There is reason to believe that, in the future, floating premiums based on your pre-existing conditions will make a comeback. If you think that you're at risk for OSA, it may be wise to hedge your bets and consider having a private sleep study that does not get documented in your permanent medical record.