HIGHMARK COMMERCIAL MEDICAL POLICY - PENNSYLVANIA

 
 

Medical Policy:
Z-8-069
Topic:
Diagnosis and Treatment of Obstructive Sleep Apnea in Adults
Section:
Miscellaneous
Effective Date:
October 1, 2023
Issued Date:
October 1, 2023
Last Revision Date:
September 2023
Annual Review:
February 2023
 
 

Obstructive sleep apnea (OSA) diagnosis is based upon the presence or absence of related symptoms, as well as the frequency of respiratory events during sleep (e.g., apneas, hypopneas, and respiratory effort related arousals [RERAs]) as measured by polysomnography (PSG) either in a clinic/facility or at home.

OSA is characterized by:

  • Fifteen (15) or more predominantly obstructive respiratory events (apneas, hypopneas, or RERAs) per hour of sleep (for PSG) or recording time (for at home PSG), regardless of the presence of associated symptoms or comorbidities; or 
  • Five (5) or more predominantly obstructive respiratory events (obstructive and mixed apneas, hypopneas, or RERAs) per hour of sleep (for PSG) or recording time (for at home PSG) in an individual and at least ONE of the following:
    • Habitual snoring or breathing interruptions; or 
    • Hypertension, mood disorder, cognitive dysfunction, coronary artery disease, stroke, congestive heart failure, atrial fibrillation, or Type II Diabetes Mellitus (DM); or
    • Sleepiness, non-restorative sleep, fatigue, or insomnia symptoms; or 
    • Morning headache; or
    • Waking up with breath holding, gasping, or choking. 

OSA severity classification is based on two (2) measures:

  • Apnea/hypopnea index (AHI) which includes the total number of apneas and hypopneas recorded during sleep, divided by the hours of sleep recorded; or
  • Respiratory disturbance index (RDI) which includes the total number of apneas, hypopneas, and RERA during sleep, divided by the hours of sleep observed. 

NOTE: Severity classification:

  • Mild OSA: RDI or AHI five (5) to 15 respiratory events per hour of sleep.
  • Moderate OSA: RDI or AHI 15 to 30 respiratory events per hour of sleep. 
  • Severe OSA: RDI or AHI greater than 30 respiratory events per hour of sleep.

 

Policy Position

Initial Sleep Study

Home, Study

  • A home sleep study in patients >18 years of age that includes a minimum of four (4) recording channels including oxygen saturation, respiratory movement, airflow, and EKG or heartrate or peripheral arterial tone (PAT), oximetry, heart rate and actigraphy is considered medically necessary if ALL the following criteria are met:
    • At least two (2) or more of the following must be present:
      • Observed apneas during sleep; or
      • Frequent snoring or choking/gasping during sleep; or
      • Excessive daytime sleepiness documented by history or with an Epworth Sleepiness Scale greater than ten (10); or
      • Treatment resistant hypertension; or
      • Obesity with Body Mass Index (BMI) >35 kg/m2; or
      • Patients scheduled for bariatric surgery; or
      • STOP-BANG score of >5; or
      • Coronary Artery Disease; or
      • Cardiac disease; or
      • Diabetes; or
      • Crowded airway
    • None of the following contraindications for a home, unsupervised study are present
      • History of significant arrhythmias, such as atrial fibrillation, periods of supraventricular or ventricular tachycardia, or bradyarrhythmias; or
        • NOTE: The presence of occasional atrial or ventricular extra beats is not considered a significant arrhythmia.
      • Congestive heart failure (Ejection Fraction (EF) <35% or NYHA Class III or IV); or
      • Moderate to severe COPD, as indicated by FEV1/FVC of <70% and FEV1 <80% of predicted value; or
      • Oxygen dependence; or
      • Suspected central sleep apnea; or
      • Suspected obesity-hypoventilation syndrome; or
      • Neuromuscular disorders with sleep related symptoms; or
    • Home sleep studies must be interpreted by a qualified physician or an active staff member of a sleep center or laboratory accredited by the AASM or The Joint Commission.
  • Home sleep studies not meeting the criteria as indicated in this policy considered not medically necessary.
  • The performance of multiple consecutive nights of Home sleep studies are ALL of the following:
    • Recognized as one (1) study; and
    • Will be paid as one (1) service; and
    • The date of service is reported as the date the study is complete.

In-lab Sleep Study

  • A minimum of seven (7) recording channels (including electroencephalography (EEG), electrooculogram (EOG), chin electromyography (EMG), electrocardiogram (ECG) or heart rate, airflow, respiratory effort, and oxygen saturation) performed in a sleep facility/laboratory may be considered medically necessary in individuals with a moderate or high pretest probability of OSA for 1 or more of the following indications which degrade the accuracy of portable monitoring: 
    • Moderate to severe pulmonary disease; or 
    • Neuromuscular disease (e.g., myotonic dystrophy, Parkinson’s disease, or ALS); or 
    • Neuromuscular disorders with sleep-related symptoms including stroke with residual respiratory effects or muscular defects which make performing an at-home sleep test difficult; or 
    • Physical or cognitive impairment making Home Sleep Testing impossible; or 
    • Epilepsy; or 
    • Congestive heart failure NYHA class III or IV or LVEF <45%; 
    • Atrial fibrillation; or 
    • Pulmonary hypertension; or 
    • Chronic opioid use; or 
    • BMI > 45  or obesity-hypoventilation syndrome which may manifest as the inability to lie flat in bed.
  • An in-lab sleep test may be medically necessary if the member has 1 or more of the following comorbid sleep disorders:
    • Periodic limb movement disorder; or 
    • Severe insomnia; or
    • Central sleep apnea or complex sleep apnea; or
    • The member has or is suspected to have 1 or more of the following
      • Potentially injurious parasomias in which treatment would depend on a sleep test; or
      • Narcolepsy; or
      • Suspected narcolepsy; or
      • Suspected idiopathic hypersomnia
  • An in-lab sleep test may be medically necessary in 1 or more of the following situations:
    • Individual lacks the mobility or dexterity to use an at-home sleep test safely; or
    • Cognitive impairment; or 
    • Individual has a technically inadequate at home sleep test or a negative home sleep test in an individual with a high pre-test probability of OSA; or 
    • To titrate CPAP in persons diagnosed with clinically significant OSA for whom in-laboratory NPSG was medically necessary, but who were unable to undergo a split-night study because they had an insufficient AHI (less than 15) during the first two hours of an attended NPSG; or 
    • To monitor results from CPAP in persons with OSA who have persistent significant symptoms (disturbed sleep with significant arousals) despite documented AHI less than 5 on CPAP and documented compliance with CPAP (CPAP used for 70 percent of nights for four or more hours per night, for two or more months)

Repeat Sleep Studies

  • Home Sleep Study
    • A repeat home sleep study is considered medically necessary if criteria for an initial diagnostic in lab sleep study are met for 1 or more of the following circumstances:
      • To assess efficacy of surgery or oral appliances or devices; or
      • To reevaluate the diagnosis of OSA and need for CPAP, e.g., if there is a significant change in weight or change in symptoms suggesting that CPAP should be re-titrated or possibly discontinued; or

A repeat home, unsupervised sleep study is not meeting the criteria as indicated in this policy considered not medically necessary.

  • In-lab Sleep Study
    • A repeat in-lab, supervised sleep study is considered medically necessary if criteria for an initial diagnostic in lab sleep study are met for 1 or more of the following circumstances:
      • To assess efficacy of surgery or oral appliances or devices; or
      • To reevaluate the diagnosis of OSA and need for CPAP, e.g., if there is a significant change in weight or change in symptoms suggesting that CPAP should be re-titrated or possibly discontinued; or
      • For any patient (even if prior testing was a home, unsupervised sleep study) who requires titration for BiPAP because of a recurrence of symptoms or worsening of symptoms during treatment with CPAP, severe OSA (AHI greater than 30-40); or

NOTE: A repeat in-lab, supervised sleep study is not meeting the criteria as indicated in this policy considered not medically necessary.

NOTE: Multiple consecutive nights of attended or unattended sleep studies not meeting the criteria as indicated in this policy considered not medically necessary.

Treatment with CPAP & BiPAP

  • CPAP may be considered medically necessary in individuals >18 years of age with clinically significant OSA, as defined by 1 or more of the following:
    • An AHI, RDI, or REI ≥15; or 
    • An AHI, RDI, or REI ≥5 in a individual with symptoms of OSA
  • Bilevel positive airway pressure (BiPAP) or APAP may be considered medically necessary in individuals with 1 or more of the following: 
    • Clinically significant OSA who have failed a prior trial of CPAP; or
    • Individuals whose bilevel positive airway pressure is found to be more effective in the sleep lab.

95800

95801

95803

95805

95806

95807

95808

95810

95811

G0398

G0399

G0400

 

 




Multiple Sleep Latency Test (MSLT)/Maintenance of Wakefulness Test (MWT)

MSLT/MWT following a supervised PSG may be considered medically necessary for the following:

  • To exclude or confirm:
    • Narcolepsy; or
    • Idiopathic hypersomnia; or
    • Suspected idiopathic hypersomnia

MSLT/MWT is not considered a stand-alone test in the diagnosis of OSA.

MSLT/MWT not meeting the criteria as indicated in this policy is considered not medically necessary.

95805

 

 

 

 

 

 




Actigraphy 

Actigraphy may be considered medically necessary when used as a component of PSG in order to evaluate sleep disorders.  When used as a component of PSG actigraphy should not be reported separately.

Actigraphy used as a sole technique to record and analyze body movement to evaluate sleep disorders not meeting the criteria as indicated in this policy is considered not medically necessary.

95803

 

 

 

 

 

 




Related Policies

Refer to Medical Policy E-20, Devices Used for the Treatment of Obstructive Sleep Apnea in Adults, for additional information.

Refer to Medical Policy S-280, Surgical Treatment for Obstructive Sleep Apnea, for additional information.

Refer to Medical Policy Z-64, Diagnosis and Treatment of Obstructive Sleep Apnea in Children, for additional information.


Professional Statements and Societal Positions Guidelines

American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) –2019

The American Academy of Otolaryngology-Head and Neck Surgery considers upper airway stimulation (UAS) via the hypoglossal nerve for the treatment of adult obstructive sleep apnea syndrome to be a safe and effective second-line treatment of moderate to severe obstructive sleep apnea in patients who are intolerant or unable to achieve benefit with positive pressure therapy.

American Academy of Sleep Medicine (AASM) Oral Appliance Therapy – 2015 The AASM along with the American Academy of Dental Sleep Medicine (AADSM) engaged a seven member task force for the treatment of OSA and snoring with oral appliance therapy developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations.

Recommendations:

  • We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult [individuals] who request treatment of primary snoring (without obstructive sleep apnea).
  • When oral appliance therapy is prescribed by a sleep physician for an adult [individuals] with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices.
  • We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult [individuals] patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy.
  • We suggest that qualified dentists provide oversight— rather than no follow-up—of oral appliance therapy in adult [individuals] with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence.
  • We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for [individuals] fitted with oral appliances.
  • We suggest that sleep physicians and qualified dentists instruct adult [individuals] treated with oral appliances for obstructive sleep apnea to return for periodic office visits— as opposed to no follow-up—with a qualified dentist and a sleep physician. 

Diagnosing OSA in Adults – 2017

The following recommendations from the AASM are intended as a guide for clinicians diagnosing OSA in adults. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the [individual], available diagnostic tools, accessible treatment options, and resources.

Good Practice Statements regarding diagnostic testing:

Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult [individuals] in whom there is a concern for OSA based on a comprehensive sleep evaluation. Recommendations:

  • We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. 
  •  We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. 
  • We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. 
  • We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in [individuals] with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. 
  • We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. 
  •  We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. 

Clinical Use of a Home Sleep Apnea Test – 2017

It is the position of the American Academy of Sleep Medicine (AASM):

  • Only a physician can diagnose medical conditions such as OSA and primary snoring. Throughout this statement, the term “physician” refers to a medical provider who is licensed to practice medicine. A home sleep apnea test (HSAT) is an alternative to polysomnography for the diagnosis of OSA in uncomplicated adults presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA.
  • The need for, and appropriateness of, an HSAT must be based on the [individual's] medical history and a face-to-face examination by a physician, either in person or via telemedicine; 
  • An HSAT is a medical assessment that must be ordered by a physician to diagnose OSA or evaluate treatment efficacy; 
  • An HSAT should not be used for general screening of asymptomatic populations; diagnosis, assessment of treatment efficacy, and treatment decisions must not be based solely on automatically scored HSAT data, which could lead to sub-optimal care that jeopardizes [individual] health and safety;
  • The raw data from the HSAT device must be reviewed and interpreted by a physician who is either board-certified in sleep medicine or overseen by a board-certified sleep medicine physician. 

Use of Actigraphy in Adult and Pediatric [Individuals] – 2018

The following AASM recommendations are intended as a guide for clinicians using actigraphy in evaluating [individuals] with sleep disorders and circadian rhythm sleep-wake disorders, and only apply to the use of FDA-approved devices. Each recommendation statement is assigned a strength (“Strong” or “Conditional”). A “Strong” recommendation (i.e, “We recommend…”) is one that clinicians should follow under most circumstances. A “Conditional” recommendation (i.e, “We suggest…”) reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding any specific care must be made by the treating clinician and the patient, taking into consideration the individual circumstances of the patient, available treatment options, and resources.

  • Suggest clinicians use actigraphy to estimate sleep parameters in adult [individuals] with insomnia disorder. 
  • Suggest clinicians use actigraphy in the assessment of pediatric [individuals] with insomnia disorder. 
  • Suggest clinicians use actigraphy in the assessment of adult [individuals] with circadian rhythm sleep-wake disorder.  
  • Suggest that clinicians use actigraphy in the assessment of pediatric [individuals] with circadian rhythm sleep-wake disorder.
  • Suggest clinicians use actigraphy integrated with home sleep apnea test devices to estimate total sleep time during recording (in the absence of alternative objective measurements of total sleep time) in adult [individuals] suspected of sleep-disordered breathing.
  • Suggest clinicians use actigraphy to monitor total sleep time prior to testing with the Multiple Sleep Latency Test in adult and pediatric [individuals] with suspected central disorders of hypersomnolence.
  • Suggest clinicians use actigraphy to estimate total sleep time in adult [individuals] with suspected insufficient sleep syndrome.
  • Recommend clinicians not use actigraphy in place of electromyography for the diagnosis of periodic limb movement disorder in adult and pediatric [individuals]. 

Treatment of OSA with PAP Therapy – 2019

Based on expert consensus from the AASM, the following good practice statements and their implementation is necessary for appropriate and effective management of [individuals] with OSA treated with positive airway pressure:

  • Treatment of OSA with PAP therapy should be based on a diagnosis of OSA established using objective sleep apnea testing.
  • Adequate follow-up, including troubleshooting and monitoring of objective efficacy and usage data to ensure adequate treatment and adherence, should occur following PAP therapy initiation and during treatment of OSA. 

The following recommendations are intended as a guide for clinicians using PAP to treat OSA in adults. A STRONG (i.e, “We recommend…”) recommendation is one that clinicians should follow under most circumstances. A CONDITIONAL recommendation (i.e, “We suggest…”) reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all [individuals]. The ultimate judgment regarding any specific care must be made by the treating clinician and the [individuals], taking into consideration the individual circumstances of the [individuals], available treatment options, and resources.

  • We recommend that clinicians use PAP, compared to no therapy, to treat OSA in adults with excessive sleepiness.
  • We suggest that clinicians use PAP, compared to no therapy, to treat OSA in adults with impaired sleep-related quality of life.
  • We suggest that clinicians use PAP, compared to no therapy, to treat OSA in adults with comorbid hypertension.
  •  We recommend that PAP therapy be initiated using either APAP at home or in-laboratory PAP titration in adults with OSA and no significant comorbidities.
  • We recommend that clinicians use either CPAP or APAP for ongoing treatment of OSA in adults.
  • We suggest that clinicians use CPAP or APAP over BPAP in the routine treatment of OSA in adults.
  • We recommend that educational interventions be given with initiation of PAP therapy in adults with OSA.
  • We suggest that behavioral and/or troubleshooting interventions be given during the initial period of PAP therapy in adults with OSA..
  • We suggest that clinicians use telemonitoring-guided interventions during the initial period of PAP therapy in adults with OSA.


Covered diagnosis code for procedure codes 95807, 95808, 95810, 95811

E11.9

E13.9

E66.2

F51.01

F51.02

F51.03

F51.09

F51.11

F51.12

F51.19

F51.3

F51.4

G25.81

G45.9

G47.00

G47.10

G47.11

G47.12

G47.13

G47.14

G47.19

G47.20

G47.29

G47.30

G47.31

G47.33

G47.34

G47.36

G47.37

G47.39

G47.411

G47.419

G47.421

G47.429

G47.50

G47.51

G47.52

G47.53

G47.54

G47.59

G47.61

G47.69

I10

I1A0

I25.10

I27.20

I27.21

I27.22

I27.23

I27.24

I27.89

I48.0

I48.11

I48.19

I48.20

I48.21

I48.91

I49.8

I50.20

I50.21

I50.22

I50.23

I50.30

I50.31

I50.32

I50.33

I50.40

I50.41

I50.42

I50.43

I50.9

I63.50

I63.511

I63.512

I63.513

I63.519

I63.521

I63.522

I63.523

I63.529

I63.531

I63.532

I63.533

I63.539

I63.541

I63.542

I63.543

I63.549

I63.59

I63.81

I63.89

I63.9

I67.841

I67.848

M95.4

R00.0

R00.1

R06.3

R06.83

Z68.30

Z68.31

Z68.32

Z68.33

Z68.34

Z68.35

Z68.36

Z68.37

Z68.38

Z68.39

Z68.41

Z68.42

Z68.43

Z68.44

Z68.45

 

 

 

 

 

Covered diagnosis codes for procedure codes 95803, 95805

G47.411

G47.419

G47.421

G47.429

 

 

 

Covered diagnosis codes for procedure codes 95800, 95801, 95806, G0398, G0399

F51.19

G47.10

G47.11

G47.12

G47.13

G47.19

G47.30

G47.33

G47.39

R63.4

Z68.35

Z68.36

Z68.37

Z68.38

Z68.39

Z68.41

Z68.42

Z68.43

Z68.44

Z68.45 

 

Non-covered diagnosis codes for procedure codes 64999, 95803, 95807, G0400, are considered experimental/investigational when reported with OSA

  G47.33



Place of Service: Inpatient/Outpatient

Experimental/Investigational (E/I) services are not covered regardless of place of service.

Diagnosis and treatment of OSA is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting.


The policy position applies to all commercial lines of business



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This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical or other circumstances may warrant individual consideration, based on review of applicable medical records, as well as other regulatory, contractual and/or legal requirements.

Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.

Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The Claims Administrator/ Insurer:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages

If you need these services, contact the Civil Rights Coordinator.

If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

This information is issued by Highmark Blue Shield on behalf of its affiliated Blue companies, which are independent licensees of the Blue Cross Blue Shield Association.  Highmark Inc. d/b/a Highmark Blue Shield and certain of its affiliated Blue companies serve Blue Shield members in the 21 counties of central Pennsylvania. As a partner in joint operating agreements, Highmark Blue Shield also provides services in conjunction with a separate health plan in southeastern Pennsylvania.  Highmark Inc. or certain of its affiliated Blue companies also serve Blue Cross Blue Shield members in 29 counties in western Pennsylvania, 13 counties in northeastern Pennsylvania, the state of West Virginia plus Washington County, Ohio, the state of Delaware[ and [8] counties in western New York and Blue Shield members in [13] counties in northeastern New York].  All references to Highmark in this document are references to Highmark Inc. d/b/a Highmark Blue Shield and/or to one or more of its affiliated Blue companies.





Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The Claims Administrator/ Insurer:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

  • Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages
  • If you need these services, contact the Civil Rights Coordinator.

    If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295 , TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.

    You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

    U.S. Department of Health and Human Services
    200 Independence Avenue, SW
    Room 509F, HHH Building
    Washington, D.C. 20201
    1-800-368-1019, 800-537-7697 (TDD)

    Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.