1. Home Sleep Testing Companies Sheila Walsh

2. 1800CPAP.com $249.00 cash out of pocket for the patient. If the test is positive for sleep apnea they will send a prescription along with the interpreted report. They offer 15% off the cost of CPAP if it is purchased through them. Treatment always suggests PAP

3. NovaSom Uses the Accusom System Direct shipment to the patient at home Bill insurance directly Offer a cash option when there are no benefits or high deductable. Cash option is $297.00 this is payable in 3 payments of $ 99.00 each in a 60 day period. Recommendation for treatment are for CPAP or APAP only (Helena)

4. Home Sleep Solutions - HSS Unable to reach anyone during the day. Still in the process of getting information.

5. ionmysleep CPAP Focused

6. Snap Diagnostics Willing to place the equipment and disposables in your practice. Will bill the insurance companies directly. cash option varies based on the patient Type III Consignment or drop ship Boarded sleep specialist for interpretations Dr. Gil Reviv, President – open to conversations regarding interpretations. No direct recommendations they word it as treatment options might include CPAP, APAP OR Dental Device when the AHI is less than 30

7. SleepMed – (WaterMark) Unit leasing Fee for each study processed Interpretation Fee if done by their physician. May or may not recommend OAT. Depends on the physician that interprets a particular study.

8. NightHawk Night Hawk provides the testing systems Each test is $ 125.00. Night Hawk – Primary patient population Provides the equipment and disposables Determines the patients benefits and collects from the patient directly Provides sleep boarded interpretation Reimburses $ 20.00 for sleep study application to the LLC Utilizes the dentist’s LLC for setup of all referred home sleep studies in the local area Provides prescription for CPAP and for Oral Appliance for positive studies.

9. Night Hawk Night Hawk - Dentist Office Provides the equipment and disposables Dentist Pays (does not require a prescription for the study from the primary physician) Provides sleep boarded interpretation Reimburses $ 20.00 for sleep study application to the LLC Utilizes the dentist’s LLC for setup of all referred home sleep studies in the local area Reimburses the LLC $ 50.00 for CPAP set-up/Mask Fit – Charge the patient $750.00. Provides prescription for CPAP and for Oral Appliance for positive studies. Includes additional 2 studies for patients who get an oral appliance They are using Watermark. Robert Rudowski, M.D. 586-489-1193

10. EZ SLEEP DROPSHIPS THE HST UNITS TO THE PATIENT’S HOME. BILLING IS BETWEEN EZSLEEP, THE PATIENT AND THE INSURANCE COMPANY. EZSLEEP PROVIDES COMPLETE VERIFICATION OF BENEFITS FOR HST, IN LAB POLY, CPAP THERAPY AND OAT THERAPY. THIS IS PROVIDED WITH THE INTERPRETATION. COST OF THE STUDY IS $495.00 PATIENT PAY CASH OPTION. ONE OR TWO NIGHTS OF STUDY ARE DONE. A PROGRAM THAT THE DENTIST CAN JOIN THAT PROVIDES AN APNEA GUARD FOR EVERY POSITIVE STUDY. $199.00 MONTH CONTACT: RYAN JAVANBAHKT, 888-240-7735

11. 2 nights of recording / 2 nights of billing HIGH LEVEL DEDUCTABLES GENERALLY MET FOLLOWING BILLING FOR THE HST’S Apnea Guard Program No Contracts or Joining Fees PRACTICE REGISTRATION FORM IS REQUIRED. NO CONTRACTS OR FEES DUE FROM THE PHYSICIAN FOR HST PROGRAM Interpreting Physician MAY CONTINUE TO UTILIZE YOUR CURRENT INTERPRETING PHYSICIAN IF SAID PHYSICIAN IS ADDED TO EZSLEEP AS AN INTERPRETING PHSICIAN. EZSLEEP WILL MANAGE ALL REIMBURSEMENT TO THE INTERPRETING PHYSICIAN.

14. Oral Appliance for Obstructive Sleep Apnea Practice Locations Connecticut Delaware District of Columbia Maine Maryland Massachusetts New Hampshire New Jersey New York Rhode Island Vermont 2/9/2015 9:30-11:30 am https://attendee.gotowebinar.com/register/67 11197246332210690 https://attendee.gotowebinar.com/register/67 11197246332210690 2/23/2015 1:30 pm-3:30 pm https://attendee.gotowebinar.com/register/83 40128120928905474 3/15/2015 1:30 pm-3:30 pm https://attendee.gotowebinar.com/register/73 38862255141227266

28. TREATMENT CONSIDERATIONS: The degree of apnea is severe and the patient should be referred for CPAP titration. The indication of central apnea suggests a possible diagnosis of congestive heart failure. This should be assesed if not already done. BiPAP and/or BiPAP auto SV may be needed. The patient should avoid sleeping supine; the non-supine RDI is 2.5 times less severe than the supine RDI. DISEASE MANAGEMENT CONSIDERATIONS: Perioperative complications are more likely during surgery or recovery as a result of general anesthesia, sedatives and/or narcotic pain relief medication in a patient with significant untreated OSA. Routine follow-up efficacy testing should be performed when non-CPAP therapies are prescribed since weight gain, age, alcohol consumption, and/or time spent sleeping supine can increase OSA severity.

30. TREATMENT CONSIDERATIONS: Consider nasal continuous positive airway pressure (CPAP) as the first treatment option based on the AHI severity and co-morbidities. Consider an attended CPAP titration study, given the significant heart disease. A mandibular advancement splint (MAS) or referral to an ENT surgeon for modification to the airway should be considered to reduce the potential contribution of OSA on existing diseases if the patient prefers an alternative therapy or the CPAP trial is unsuccessful. A Mandibular Advancement Splint (MAS) will likely provide treatment benefit independent of OSA severity. The patient should avoid sleeping supine; the non-supine RDI is 2.1 times less severe than the supine RDI. DISEASE MANAGEMENT CONSIDERATIONS: Perioperative complications are more likely during surgery or recovery as a result of general anesthesia, sedatives and/or narcotic pain relief medication in a patient with significant untreated OSA. Routine follow-up efficacy testing should be performed when non-CPAP therapies are prescribed since weight gain, age, alcohol consumption, and/or time spent sleeping supine can increase OSA severity.

32. TREATMENT CONSIDERATIONS: Consider treatment with nasal continuous positive airway pressure (CPAP) as the first line of therapy given the comorbidities. Can consider mandibular advancement splint (MAS), referral to an ENT surgeon for modification to the airway, and/or weight loss or behavioral therapy. An auto-PAP or an auto-PAP titration study may be appropriate. DISEASE MANAGEMENT CONSIDERATIONS: None. Study

36. TREATMENT CONSIDERATIONS: The history suggests a high pre-test probability of having severe OSA and the test shows moderate OSA. Based on these findings, I would refer the patient for CPAP titration. DISEASE MANAGEMENT CONSIDERATIONS: Narcotic pain medication increases the severity of untreated OSAand contributes to central sleep apnea. Morning headaches are symptoms that can be associated with untreated OSA. Perioperative complications are more likely during surgery or recovery as a result of general anesthesia, sedatives and/or narcotic pain relief medication in a patient with significant untreated OSA. Routine follow-up efficacy testing should be performed when non-CPAP therapies are prescribed since weight gain, age, alcohol consumption, and/or time spent sleeping supine can increase OSA severity.