Sleep Study Out-of-Pocket Estimator

Preview the cash you will owe for an attended sleep study before scheduling. Provide the allowed charge, how much deductible is left, and your coinsurance rate to see the patient share, insurer payment, and whether the out-of-pocket cap will limit your bill. Optional fields layer in fixed copays or the remaining out-of-pocket maximum to reflect your plan design.

The insurer's contracted rate for the overnight polysomnogram, including technical and professional components.
Amount of your annual deductible that still needs to be met before coinsurance applies.
Patient share of the remaining allowed amount once the deductible is satisfied.
Flat copay due at check-in. Defaults to $0.00 when blank.
Remaining headroom before you hit the annual out-of-pocket maximum. Defaults to unlimited when blank.

Benefits vary by carrier and network agreements. Confirm prior authorization, medical necessity, and cost-share details with your insurer before the study date.

Examples

  • $3,200 allowed, $900 deductible remaining, 20% coinsurance, $150 copay, $2,500 OOP cap ⇒ Patient cost: $1,510.00 USD • Insurer pays: $1,840.00 USD • Deductible applied: $900.00 USD • Coinsurance owed: $460.00 USD • Copay added: $150.00 USD • Coverage rate on allowed amount: 57.50%.
  • $2,450 allowed, deductible met, 10% coinsurance, copay blank, $500 OOP cap ⇒ Patient cost: $245.00 USD • Insurer pays: $2,205.00 USD • Deductible applied: $0.00 USD • Coinsurance owed: $245.00 USD • Copay added: $0.00 USD • Coverage rate on allowed amount: 90.00%.

FAQ

Does this include separate physician interpretation fees?

Yes if the interpretation is bundled into the allowed amount you entered. If your plan bills the professional read separately, run a second estimate using that contracted amount.

What if I use a home sleep apnea test instead?

Home tests typically have lower allowed amounts. Enter the contracted charge for the home kit to compare out-of-pocket exposure versus an in-lab study.

How should I handle pre-paid deposits?

If the sleep center requires a deposit, subtract it from the patient cost output to see how much more you will owe at billing, or include it in the copay field to treat it as upfront cash.

Will the result change if I have secondary insurance?

This calculator models your primary plan only. Apply the output as the starting balance and then run your secondary plan's benefits to see how much of the remainder gets reimbursed.

Additional Information

  • Deductible is applied first up to the allowed amount; coinsurance only applies to the remaining balance after deductible.
  • If the out-of-pocket maximum would be exceeded, the calculator caps the patient responsibility and shifts the excess back to the insurer.
  • Copays are added on top of deductible and coinsurance obligations, even if the allowed amount is fully covered by insurance.
  • The coverage rate highlights the portion of the allowed charge the plan pays so you can compare in-network and out-of-network sleep labs.

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