Beginning with December 1, 2012, dates of service, cost-sharing (deductible,
coinsurance, and/or copayments) will apply to sleep studies for all commercial
HMO and POS members in Pennsylvania and all HMO, POS, and PPO members in
Delaware*. Members will be responsible for the same cost-sharing that is
applied to their routine radiology benefit.
Cost-sharing varies based on the member?s type of coverage and benefit plan.
Providers can view a summary of member benefits on the NaviNet
? web
portal. Cost-sharing for sleep studies can be found under "Routine
Radiology/Diagnostic" within the Benefit Snapshot when using the
Eligibility
and Benefits Inquiry transaction. Providers without NaviNet access must
contact Customer Service at
1-800-275-2583 to
determine the appropriate member cost-share responsibility.
Please refer to our
Medical Policy website for detailed information on our coverage of sleep
disorder testing.
* All Delaware Small Employer Health Plans are
excluded.
NaviNet? is a registered trademark of NaviNet,
Inc.