Reimbursement Committee
Omar Burschtin (Chair) [email protected], Jay Enden, Gurmit Gil, David Appel, Ken Plotkin,Thomas Kilkenny
Mission Statement: The Reimbursement committee is responsible for reviewing New York State sleep medicine reimbursement policies and ensuring appropriate sleep policies for patients and practicing physicians.
Emblem Heath Care : Emblem has taken over GHI and HIP. Emblem is now insisting that all sleep studies be home studies but in addition their specific vendor must be used. The vendor mails the patient a home sleep kit. The patient performs the study themselves and then the equipment is forwarded back to the vendor for a computerized analysis (no human involvement) then a
summary is forwarded to the ordering physician (which can be any physician) who then interprets the test and submits an interpretation fee. This violates almost all of the AASM guidelines for home sleep testing.
AETNA: Aetna is requiring physicians to sign up for home sleep testing.
This is a disturbing trend. Please email NYSSSM and the Reimbursement Committee with any other insurance company activities regarding home testing.