It is important to find a certified sleep specialist, as sleep disorder medicine is relatively new, and very few doctors have been trained in it. According to a survey, 20 minutes was the average time spent teaching sleep medicine, and sleep apnea surgery in medical schools.
Your doctor might want to refer you to someone who isn’t board-certified in sleep medicine, or doesn’t practice it full time because of financial arrangements and managed care. Check to see if your plan is “capitated”.
This means that each time your doctor orders a test, it costs the clinic money. Capitated settings are more likely to deny you care or offer lower quality or unproven services. Although the doctor may not be conscious of trying to save money, they may be too eager to believe that some service is “cheaper” or “just as good.”
But do you really want to be the exception? Most established specialties, such as pediatrics, obstetrics/gynecology, otolaryngology psychiatry, and so on, have their own departments in hospitals and medical schools. Specialists in these fields teach medical students, who learn how to diagnose and treat illnesses. Doctors can spend many years in residency programs after graduation to perfect their skills in the chosen specialty.
However, there are very few schools that offer programs or courses in sleep disorders medicine. Therefore, only a few doctors are qualified to diagnose and treat sleep disorders. Early sleep medicine specialists created a professional organization in order to set the standard for professionalism in this field. The American Academy of Sleep Medicine (www.aasmnet.org), today establishes standards for evaluation and treatment of sleeping disorders and gives accreditation to sleep disorder centers.
The American Board of Sleep Medicine certifies and tests sleep medicine specialists. The field of sleep disorders medicine is expanding rapidly. The AASM hopes that within a few years, all major medical schools will offer programs on sleep disorders. The public will need to be careful to find a qualified sleep specialist until systematic sleep medicine training is integrated into the medical school curriculum.
Qualifications for a Sleep Specialist
The AASM defines a sleep specialist to be “a doctor who is. . . AASM members include more than 6,000 doctors, researchers, and other health care, professionals.
Find a Board Certified Sleep Specialist
Specialists in sleep medicine are doctors who have completed medical school to continue their studies and then enrolled in graduate courses or fellowship programs. The American Board of Sleep Medicine (ABSM) certifies a physician to be a sleep specialist.
He is now a board-certified sleep specialist (BCSS). The American Board of Sleep Medicine has a list of certified sleep specialists that you can find online at www.absm.org. You can also call the American Board of Sleep Medicine (507 287-9819) to inquire if a specific doctor is certified in sleep medicine.
Many doctors who have been trained in sleep medicine are not certified. They may still be knowledgeable about sleep disorders. As with any medical specialty, board certification in sleep medicine ensures that you, the patient, have received specific training and are qualified to perform sleep testing and interpret the results. A sleep study at an accredited clinic is a must before you begin a treatment program. This is especially true if surgery is involved.
Standards for Accredited Sleep Centers
An AASM-accredited sleep center is one that meets the requirements. There were over 1,000 accredited laboratories and sleep centers in the United States as of summer 2007. There were also thousands of accredited sleep laboratories that are not recognized by the AASM. Although no one knows how many of these sleep laboratories are accredited, the AASM has received thousands upon thousands of inquiries from sleep laboratories seeking information on accreditation.
Although a non-accredited laboratory might be reputable, you don’t have the ability to verify this. Your family physician may not be familiar with all aspects of quality sleep medicine and may refer you to someone from his group.
There is a wide variety of quality, from reputable sleep labs to those on the street. The AASM does not have the resources, staff, or mandate to “police the whole field of sleep medicine beyond its membership. Until now, however, there has been no other agency or organization that is monitoring the quality of the sleep testing performed in non-AASM-accredited labs.
Find a Accredited Sleep Center
You can be a responsible consumer and choose an AASM-accredited sleep center if you are looking for assurances of professionalism in this new field. The Internet allows you to find accredited centers for sleep disorders in your state at www.aasmnet.org. Click on Patients and Public then click on Find a Sleep Center. There are two types of accreditation standards: specialty laboratories and full-service centers.
All-Service Sleep Centers
Accreditation for a full-service center for sleep disorders ensures that it can deal with all types of sleep disorders professionally. These are the AASM’s primary requirements for a full-service sleep center.
- The center must have an ABSM-accredited medical polysomnographer (MD) or Ph.D. on staff to interpret and read the sleep recordings.
- The center must have a full-time doctor who is an expert in sleep physiology. It must be able to provide sleep testing services by certified technicians. It is a good idea to have at minimum one registered polysomnographic technologist in a sleep center.
- Each patient must have their own private room with sound, light, and temperature control. They also need easy communication with the attendant.
- All facilities, procedures, and patient care must conform to the standards of the ABSM. A two-member accreditation committee must inspect the sleep center every five years to ensure that it is not disqualified.
Laboratories of Specialty
While the standards for specialty laboratories are similar, they are tailored to sleep testing roles. The majority of specialty laboratories deal with pulmonary medicine (breathing problems), and their diagnostic testing is primarily for sleep apnea. A specialty laboratory must have at minimum one pulmonary specialist.
- Staff must have knowledge about the procedures and practices of sleep disorders medicine.
- All aspects of patient care, including the physical environment, facilities, testing procedures, and patient care, must be in line with ABSM standards.
What to do if you are denied referral to a qualified sleep specialist or laboratory
It is important to be aware of these guidelines when you are receiving a denial, delay, or other administrative notice regarding your health care.
- First, if you have an urgent need or it is an emergency, you should immediately seek the treatment you require and not delay in seeking referrals or insurance coverage.
- Second, remain calm. You’re not the only one. Healthcare is complex and large. It can sometimes take patience to navigate the healthcare system.
- Third, continue calling your insurance company, follow up with their processes, and keep track of names, claim numbers, and other details.
The following guidelines apply to sleep disorders. Sleep problems are not usually life-threatening. However, if you have an urgent need for medical attention, it is a good idea to get it. When the staff at the office ask for billing information or a referral, tell them about the situation and promise to follow up. Take all information that you can, such as your cards and health insurance, doctor visits information, bills, and other pertinent information. Tell the insurance company about your situation as soon as you can.
Keep the name of the person with whom you spoke. It may not seem like much, but it could make a difference in the future. Prepare to tell your story to many people. Before you start, a speakerphone or another hands-free phone is a good investment.
It’s not uncommon to spend a lot of time on your phone. Be persistent. Be persistent if you don’t get the answer you want. Sometimes, your primary care physician can help you appeal. Your doctor might be able to write a letter for you or can send your medical records to your insurer.
Do not give up and just go anywhere!
If appeals fail, you can write to your state’s insurance commissioner. You can find their number by calling the government information number in your state capital. Each state has an office or individual who supervises insurance plans and HMOs. Insurance commissioners are keen to identify these kinds of issues due to well-publicized cases of abuse.
How to Find the nearest Accredited Sleep Center or Sleep Specialist
A booklet with a list of accredited American sleep centers will be mailed by the AASM. The following address is where you can write to the AASM. Include a large, self-addressed, stamped envelope.
- American Academy of Sleep Medicine
- 1610 14th Street NW Suite 300
- Rochester MN 55901-2200
- (507) 287-6006
- www.aasmnet.org
- American Board of Sleep Medicine
- (507) 287-9819
- www.absm.org