Good news for insured individuals! Because currently... Sleep Test (Social Security Coverage) Reimbursement is now available, including the cost of medical equipment such as CPAP machines. This article will guide you through every step, from checking your eligibility and preparing to the reimbursement process, so you can access quality medical care without worrying about the cost.

What is a sleep test, and what conditions can it diagnose?

Before we look at social security benefits, let's first understand what... Sleep Test What is a sleep study? Sleep Test This is an internationally standardized diagnostic test for sleep disorders. Doctors evaluate physiological data using sensors implanted on the body while you sleep.

A sleep test doesn't just check for snoring; it can also help diagnose diseases and the functioning of various bodily systems, including:

Electroencephalogram (EEG): To observe the depth of sleep (sleep stages), indicating how deeply asleep or how much dreaming occurs.
Breathing: Detects sleep apnea and monitors blood oxygen levels to see if they drop to a dangerously low level.
Heart function test (EKG): Screening for cardiac arrhythmias during sleep.
Behavior during sleep: Examples include teeth grinding, leg twitching, or sleepwalking.

The test results will be used to calculate the Apnea Hypopnea Index (AHI), which indicates the severity of the condition and leads to treatment planning, whether it be the use of a CPAP machine, dental equipment, or surgery.

Can I claim social security benefits for a sleep test? (Latest update)

A frequently asked question is: “"Can I claim a sleep test result back from social security?"” The answer is... “"can"” yes

The Social Security Office has announced guidelines and rates for medical services in cases of "sleep apnea," effective from January 1, 2024. This is a significant change that will greatly reduce the financial burden on insured individuals who have sleep problems.

Who is eligible for this?

Those who will exercise their rights. Sleep test under social security benefits. Yes, but the person must be insured under the following section:

Article 33: General private sector employees
Article 39: Those who were formerly private sector employees and continued to make contributions on their own.

Important conditions: Insured persons must have contributed to the fund for at least 3 months within a 15-month period prior to receiving medical services in order to be eligible for this benefit.

What types of sleep tests are covered by social security benefits?

Social security does not pay on a lump-sum basis, but rather has clearly defined limits and types of examinations, categorized as follows: Sleep Test (Social Security Coverage) There are two main cases, as follows:

Sleep Test Type 1 (Full Polysomnography)

This type of test is the most comprehensive and must be performed in a hospital or sleep center.

Examination procedure: They were fitted with a full set of equipment to measure brainwaves, electrocardiograms, breathing, movement, and most importantly... A specialist (Sleep Technician) monitors the sleep graph throughout the night. To troubleshoot if the cable disconnects and to ensure safety.
Withdrawal limit: Pay only the actual amount, but not exceeding... 7,000 baht

Sleep Test Type 2 (Polysomnography without Technician)

This type of testing uses almost the same measurement equipment as type 1, but the difference lies in the monitoring procedure.

Examination procedure: It can measure various values with the same precision as type 1, but... No one was monitoring him while he slept. It may involve testing at the hospital while the patient is allowed to lie down on their own, or in some cases, the device may be installed and the patient sent home to rest (depending on the doctor's discretion and hospital equipment).
Withdrawal limit: Pay only the actual amount, but not exceeding... 6,000 baht

Things to know: Your doctor will determine whether you need a type 1 or 2 test based on your symptoms and risk factors. If the actual cost exceeds the coverage limit, you may have to pay the difference yourself, depending on the hospital's policy.

Additional benefits: CPAP machine and accessories included.

What makes this announcement so interesting is that it covers not only diagnostic costs but also "treatment costs" if the tests reveal you have severe sleep apnea and require a ventilator.

CPAP machine (Continuous Positive Airway Pressure Machine): Reimbursement is possible within the allocated budget. 20,000 baht (For individuals with an AHI > 15 or an AHI of 5-15 combined with high-risk underlying medical conditions)
CPAP mask: Reimbursable. 4,000 baht Per piece (one piece can be reimbursed per year if the machine is used regularly according to the criteria).
Other accessories: For example, air filters are already included in the medical service fees at healthcare facilities.

This is a great opportunity for patients because CPAP machines from standard brands on the market, such as... Philips DreamStation or ResMed AirSense 10 That is an expensive medical device. Receiving 20,000 baht in funding will significantly reduce the cost.

What symptoms warrant a sleep test?

Not everyone who snores needs to do this. Sleep Test However, if you have these symptoms as well, you should consider seeing a doctor to claim your insurance. Social security sleep test:

1. Snoring and sleep apnea.

Snoring very loudly, to the point of disturbing those nearby, or snoring alternating with periods of apnea.
Symptoms include choking on saliva or suddenly gasping for breath in the middle of the night.
The person sleeping next to him noticed periods of apnea (holding back breath).

2. Abnormal symptoms during the daytime.

I woke up this morning feeling unrested, with a headache and dizziness, like I hadn't slept at all.
Excessive daytime sleepiness; falling asleep even while sitting still (microsleep).
Short attention span, forgetful, easily irritated, mood swings.

3. High-risk groups that doctors often recommend.

People who are overweight or have a high body mass index (BMI) (abdominal obesity).
People with underlying medical conditions such as hard-to-control high blood pressure, heart disease, or diabetes.
Individuals with physical characteristics that increase risk, such as a short and thick neck, a long uvula, or enlarged tonsils.

If you experience any of these symptoms, leaving them untreated could lead to serious illnesses such as ischemic heart disease or stroke. Therefore, a sleep test is the best preventative measure.

Preparing for a Sleep Test.

In order to obtain test results. Sleep test covered by social security. To get the most accurate results, you should prepare as follows:

Wash your hair thoroughly: Wash and dry your hair the day before your exam. prohibitApplying oil, gel, or conditioner will make it difficult to attach the electrodes to the scalp.
Avoid stimulating drinks: Avoid tea, coffee, soft drinks, and alcohol for at least 24 hours before the test, as they can interfere with brainwaves and sleep.
Avoid napping: Try to avoid taking naps during the day so that you can fall asleep at your normal time at night.
Bring your regular medication with you: If you take any medication regularly, inform your doctor and bring your medication with you on the night of your appointment.
Prepare your personal belongings: Comfortable pajamas (preferably separate shirt and pants for easy attachment of devices) and personal toiletries for washing your face and brushing your teeth in the morning.

The process of taking a Sleep Test using social security benefits.

To exercise one's rights. Take a sleep test for social security benefits. It's not like you can just walk in anywhere; you have to follow the social security system protocols, as follows:

Step 1: Check your eligibility and see a doctor at the "Hospital covered by your insurance".“

This is the most important step! You must start with... The hospital where you have selected your social security benefits. (You can check this on the SSO Connect app or the Social Security website.)

Walk into the outpatient department and tell the nurse, "I have problems with snoring and sleep apnea and would like to see a doctor for an evaluation."“
A physician in the ENT (Ear, Nose, and Throat) department will take a medical history and perform an initial physical examination.

Step 2: Assessment and Transfer

Case 1: The hospital covered by your insurance has a Sleep Test center. If your doctor determines that a sleep test is necessary, you will be scheduled for a sleep test there, free of charge (subject to the doctor's terms and conditions).
Case 2: The hospital covered by your insurance "does not" have a Sleep Test center. The doctor will handle the paperwork. “"Refer"” You should go to a referral hospital or a higher-capacity hospital within the social security network that has the necessary equipment.
Caution: Do not go for a check-up at another hospital without a referral letter, because you will have to pay for it yourself and it will not be reimbursable.

Step 3: Take a Sleep Test and wait for the results.

On your appointment day, you will undergo examinations overnight. The next morning, the doctor will review the results (interpretation may take 1-2 weeks).

If the result is... Sleep Apnea And if the condition is severe enough to meet the criteria, the doctor will write a certificate to claim for a CPAP machine.
To claim reimbursement for a CPAP machine up to 20,000 baht, a medical certificate clearly stating the AHI value and the necessity for using the machine is required.

Which hospitals offer sleep tests covered by social security?

Which hospitals offer sleep tests covered by social security insurance? The answer is, "Any hospital that has a sleep study center and is part of your referral network under your insurance plan."“

List of hospitals that offer sleep tests.

An option for those who don't want to wait in long queues.

Although social security benefits can save you a lot of money, a common problem is... “"Long queues for check-ups."” In some places, there may be waiting lists of 3-6 months, which for those with severe symptoms, the wait can be agonizing and dangerous.

If you have an urgent need or require convenience, there are currently... Private clinics or sleep test centers. For faster service, you may choose a self-pay test option to receive results quickly. Then, you can take the results to consult a doctor at your designated hospital (however, this depends on the discretion of the doctor at your affiliated hospital whether they will accept results from an outside provider or if you may need to bring the results for confirmation to proceed with treatment).

NK Sleepcare We are sleep health experts and official distributors of CPAP machines. Philips and ResMed In Thailand, we understand the problem of long waiting times for patients. We are ready to provide consultation on options for testing and treatment using CPAP machines.

If you have been diagnosed with a condition requiring a CPAP machine and are eligible for reimbursement of 20,000 baht, you can choose a high-quality CPAP machine that suits your needs, such as:

Philips DreamStation Auto CPAP: A popular appliance with automatic pressure regulation, beautiful design, and easy to use.
ResMed AirSense 10 AutoSet: A machine renowned for its quiet operation and gentle airflow.

Choosing the right CPAP machine is important because you'll be using it every night. Having expert advice on the right model, proper setup, and excellent after-sales service (including a loaner machine while yours is being repaired) is our top priority at NK Sleepcare.

summarize

Exercising rights Sleep Test (Social Security Coverage) It's not as difficult as you think. You just need to start from... “"Hospitals covered by insurance"” Your information will be used to enter the screening process. If you meet the criteria, you will receive the test for free or pay only a small difference. You are also eligible for reimbursement of up to 20,000 baht for a CPAP machine, which helps more Thais access quality medical treatment.