Payer Policy Scorecard and Guidelines

The AASM regularly communicates with insurance companies to encourage that they cover the costs of quality care for patients with sleep disorders. While this advocacy is helpful, patients are encouraged to be their own health advocates, by becoming familiar with sleep disorder treatment recommendations, supported by research and sleep medicine experts, while also learning whether their insurance company will pay for those recommended treatments.

PATIENT FRIENDLY GUIDES

The AASM has developed patient-friendly guides and practice guidelines which includes key information, and terminology that is more widely understood. Patients are encouraged to review these guides to understand diagnosis and treatment options recommended by the AASM.

PAYER POLICY SCORECARDS

Payer policy scorecards were created to compare how insurance coverage policies measure up to providing medical coverage for diagnostic sleep testing services when patients are tested for obstructive sleep apnea (OSA). The policies are compared to recommendations in the AASM clinical practice guideline, which has corresponding patient-friendly guides in both English and Spanish.

Diagnostic Testing for Obstructive Sleep Apnea in Adults

Diagnostic Testing for Obstructive Sleep Apnea in Adults [Spanish]

Publishing the scorecards publicly, encourages insurers to modify policies to cover recommended tests and treatment that support patient safety and delivery of high-quality care.  Insurance policies are reviewed by the AASM Payer Policy Review Committee before being scored.  View current scorecards for Diagnostic Testing for OSA here.

Get more detailed information about the payer policy scorecard by accessing this video.

Note: The Payer Policy Scorecard initiative ended in June 2023, with a total of 51 policies scored by the AASM Payer Policy Review Committee. The final scores are included in the tables below. Visit the AASM Payer Advocacy page to learn about other AASM payer advocacy efforts.

Table 1. Total number of diagnostic testing policies reviewed and their final scores

Table 2. Improvement in scores for all revised policies after re-scoring

CONTACT YOUR INSURANCE COMPANY

We, at the AASM, realize how difficult it can be to communicate with your insurance company.  If you would like to reach out to the company, regarding coverage or denials, feel free to download the AASM payer communication template letter, to get you started.  We encourage patients to review the current version of the medical policy, prior to contacting the insurance company, and be prepared to provide a copy of the AASM clinical practice guidelines, as an additional resource.

For more information about payer policy scorecards or to submit an insurance coverage policy for review and development of a payer policy scorecard, email [email protected].