The American Academy of Sleep Medicine last week issued a letter to Scott Josephs, MD,
vice president & national medical officer, Cigna Healthcare, in response to Cigna’s policy for sleep testing.
Effective February 18, 2013, Cigna established a new Sleep Management Program supported through CareCentrix. According to Cigna, “CareCentrix will provide individuals with access to its robust network of home sleep testing facilities. As a result, individuals will have expanded access to sleep testing services in the comfort of their own home. Additionally, as part of the Sleep Management Program, all sleep testing services must be precertified for coverage… During the precertification process, we will apply medical necessity and place of service determinations for these services.”
According to the letter from the AASM, “…anecdotal reports from AASM members suggest that precertification requests for in facility polysomnography are being denied even in cases when patients meet the criteria for comorbid medical conditions or sleep disorders.”
The AASM is concerned that “Cigna/CareCentrix reviewers are failing to evaluate all preauthorization requests according to the guidelines outlined in the medical coverage policy.”
In order to respond to inquiries from AASM members, the academy asked Cigna to “conduct an audit of these requests and provide data related to the causes and frequency of denials for in facility polysomnography.”