Why A Clinic In Kolkata Is Fighting Hard To Normalize Insurance Coverage For Sleep Disorders

More than 104 million Indian adults suffer from Obstructive Sleep Apnea, a breathing disorder that interrupts the flow of oxygen while patients sleep. OSA is one of the most common forms of sleep disorders in the world, often progressing to more critical complications over time like heart attacks and brain strokes.

Treatments for sleep apnea require CPAP 바카라� a type of medical device that forces air through the windpipe as patients sleep. It may also require surgeries in some cases.

While these treatments are medically approved and have been around since the 1980s, all major insurance companies include them as a categorical exclusion in India. This includes both private insurers (HDFC Ergo, Star Health, ICICI Lombard, etc.) and public insurers (New India Assurance, National Insurance, etc.).

Patients are refused any treatment for sleep-related illnesses like OSA. In some cases, they may even be denied a policy altogether if they mention having such disorders.

But why deny claims related to sleep disorders? Somnath Maity, Director of the Institute of Sleep Science in Kolkata, says it makes no sense. 바카라�The same insurance companies are paying upwards of 5 to 10 lakh INR when these patients enter the emergency room due to heart failure. This could have been avoided if they had paid 1/10th of the amount for basic sleep apnea treatment when the patient was first diagnosed.바카라�

For the last several years, India바카라�s medical community has been repeatedly advocating for sleep disorders to be brought into the fold of medical insurance. But insurance providers have remained silent.

Patients speak

Sharmila Bhattacharya, a biology teacher at Modern High School for Girls, contacted Maity after her husband Ayan was diagnosed with sleep apnea about six years ago.

바카라�My husband was developing other health complications due to his sleep apnea,바카라� said Bhattacharya. 바카라�There were many times when he dropped unconscious on the road due to low oxygen in his blood. It could have easily led to an accident.바카라�

This is not uncommon. In fact, a study conducted by the American Academy of Sleep Medicine found that sleep apnea patients were 2.5 times more likely to be in a road accident than most people.

Sharmila바카라�s family was covered by two separate insurance policies at the time of the incident. One was a family health insurance policy from New India Assurance. The other was a group health policy arranged by Ayan바카라�s office. Both of them refused to cover any sleep apnea treatment, providing no further explanation as to why.

Eventually, the family had to pay for the CPAP device out of their own pockets. But since using the device, Ayan has had no further problems and his blood oxygen levels are always normal.

They aren바카라�t alone. Jayanta Jana, who works as an insurance agent, said that his claims were denied by New India Assurance when he was recommended for a CPAP device a few years ago. 바카라�My doctor said that if I didn바카라�t use a CPAP machine, I could have a stroke any day in my sleep.바카라� He was told that he might also require surgical treatment along with the CPAP device.

Not surprisingly, Jana바카라�s insurance claim was also denied without explanation. He says he barely has the means to buy a CPAP device, let alone do that and pay for his surgery too.

Claim denials aren바카라�t limited to CPAP devices. Nabagopal Biswas said that when he was diagnosed with sleep apnea, his doctor suggested that he go for surgery to remove his nasal polyp. Biswas went through the operation thinking that he was covered by his health insurance policy with IFFCO-Tokio. However, right when the hospital raised a cashless claim against his medical bills, his claim was denied.

Doesn바카라�t make sense

Unfortunately, this is not about a single insurance company. A closer inspection reveals that among the 28 insurance providers listed on the IRDAI바카라�s website, every single one of them includes sleep disorders as a permanent exclusion for all their health plans.

Why? While insurance companies stay silent, doctors say they are confused. 바카라�It바카라�s not like cosmetic surgery,바카라� said Dr. Dipankar Datta, an ENT surgeon who serves as the regional head of the Indian Association of Surgeons for Sleep Apnea. 바카라�OSA is a life-threatening disorder that can lead to heart failure, stroke, diabetes, blood pressure, asthma, dementia, and even car accidents.바카라�

Datta has been collaborating with Somnath Maity at the Institute of Sleep Science. Together, they have been trying to bring this to the attention of insurance providers since 2019.

They first expressed their concerns a few years back during a conference on sleep apnea at the Biswa Bangla Convention Centre. Many delegates from insurance companies attended the discussion. However, there has been no decisive action from the companies since.

Maity said there바카라�s no real reason to deny claims related to sleep disorders. If insurance companies are worried about fraud, they can set forth clear criteria to assess sleep-related claims. 바카라�But why deny access to life-saving treatment when doctors agree that it바카라�s necessary?바카라�

No diagnosis

Of course, treatment is only possible once the condition is discovered in the patient. But a diagnosis of sleep apnea requires multiple tests, including an overnight polysomnography and a sleep endoscopy. Without them, doctors can바카라�t plan the right course of treatment. Sadly, they are expensive because each test requires staying at the hospital for a day at a time.

바카라�Financial barriers discourage patients from undergoing tests, since those aren바카라�t covered under their insurance plans either,바카라� said Dr. Pallab Chatterjee, a pediatric pulmonologist who treats children with OSA. 바카라�Despite clear signs, the condition never gets diagnosed, let alone treated.바카라�

These tests are nothing out of the ordinary, explained Datta. The first step is to conduct a polysomnography, which is also called a sleep study. It involves using a machine to monitor the patient바카라�s blood oxygen as they sleep. If the report comes back positive, doctors perform a nasal endoscopy under anesthesia to see exactly where the obstruction lies.

Patients have to be hospitalized, because the tests can only be performed in a controlled environment with medical-grade equipment while they sleep, added Chatterjee. This is not possible at home.

Generally, insurance providers always reimburse patients for diagnostic tests that require a hospital stay of at least one night. Not in the case of sleep disorders. With an overnight polysomnography costing in the ballpark of Rs. 8,000-10,000 and a DISE (drug-induced sleep endoscopy) costing as much as Rs. 20,000, this is something that makes many patients hesitate.

Increasing complications

Dr. Arup Das Biswas, Former Director of Cardiology at IPGMER and SSKM Hospital, explained how untreated sleep apnea can lead to long-term heart disease in two different ways.

바카라�First, it cuts off the body바카라�s oxygen supply, causing hypoxia,바카라� he said. That leads to surges in blood pressure and heart rate. Over time, this can reduce cardiac function and lead to complications like hypertension, left ventricular hypertrophy, and atherosclerosis.

바카라�But then, there are also a number of indirect causes,바카라� he continued. OSA is often associated with obesity, insulin resistance, daytime sleepiness, etc. All of these risk factors eventually contribute to heart disease, leading to incidences of cardiac arrest and heart failure.

Of course, sleep apnea바카라�s long-term effects aren바카라�t limited to the heart. Hypoxia reduces the flow of oxygen to all parts of the body, including the brain. This leads to neurological complications, such as dementia, brain fog, cognitive impairment, and even cerebral strokes.

Similarly, complications of the respiratory system, liver, kidneys, and blood vessels are all quite common. When patients already have other comorbidities, OSA can make things much worse.

Halting progress

But the lack of sleep apnea coverage isn바카라�t just affecting those with health insurance. It바카라�s also halting the progress of India바카라�s healthcare infrastructure as a whole.

Inspire Sleep is a new FDA-approved medical implant that바카라�s showing remarkable results in patients with sleep apnea. If a patient continues to have issues after using CPAP, getting the implant can enable them to lead normal lives without relying on an external device. It바카라�s already being used by more than 50,000 people across the US and EU.

Getting the implant doesn바카라�t even require surgery, it can be attached to the body using a non-invasive procedure that takes just a few hours to complete. Once implanted, the device stimulates the nerves at the base of your tongue to keep the upper airway open while you sleep.

While the treatment is expensive, it바카라�s covered under most insurance plans in the US and many in Europe. It has been a lifeline for patients with the most severe form of sleep apnea, who often don바카라�t respond to other forms of treatment like devices or surgeries. Now, it is also being developed by other companies like Nyxoah from Belgium, who are trying to build more cost-effective solutions to improve accessibility.

But none of these solutions have entered the Indian market, explained Maity. Since they are not covered by insurance providers in the country, they don바카라�t want to invest in entering a foreign market without a clear path to profitability.

바카라�They simply don바카라�t see the Indian market as profitable,바카라� Maity said. 바카라�Even the people who could have paid for the treatment out of pocket now don바카라�t have access to it.바카라�

What바카라�s the solution?

It바카라�s not an easy road to getting standardized insurance coverage for sleep disorders across India. Experts say that it would require the involvement and cooperation of policymakers, healthcare professionals, and insurance providers alike. But it바카라�s nothing that hasn바카라�t been done before.

In 2023, the Insurance Regulatory and Development Authority of India (IRDAI) introduced guidelines that asked Indian insurers to offer standardized coverage for mental disorders across all their plans.

Before that, the stigma surrounding mental illness had caused those suffering from long-term psychiatric disorders to not have access to any insurance coverage at all.

Thanks to the guidelines from IRDAI, HDFC Ergo, Magma HDI, ICICI Lombard, Aditya Birla Capital, and Plunes HealthCare have all begun to offer cashless facilities for the treatment of mental health disorders at approved institutions. Government-sponsored schemes like Ayushman Bharat also offer coverage.

Now, healthcare professionals are hoping for a similar initiative for sleep disorders. 바카라�It바카라�s hard to think that standardized care would be possible without some change at the policy level,바카라� said Maity.

Once the IRDAI clarifies its position, he believes that insurance companies will begin to pay attention. While it may be some time before new plans get implemented, at least there will be some hope for sleep apnea patients to get the quality care they need.

is the first Level 1 Sleep Laboratory in Eastern India that바카라�s licensed to perform a polysomnography test for diagnosing sleep apnea patients. They also have a team of medical professionals who can advise and treat patients suffering from Obstructive Sleep Apnea, a respiratory disorder that causes breathing trouble during sleep.

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