why can't my primary care physician order a sleep study ? Am I being gouged ?

Are you in the US? I am not aware of such a process in Canada.

Yes. Nevada

I am a dentist working in dental sleep medicine. From a medical insurance perspective in the U.S.A., they usually will only pay for a sleep study if it is initiated AFTER an initial consultation with a physician certified in sleep medicine and the results are reported and interpreted by a physician certified in sleep medicine. As a practical matter, most family physicians have little or no knowledge about sleep disorders anyway, so it is sort of a moot point because most don't even want to get into it. If your family practitioner does, that would be unusual. Arthur B. Luisi, Jr., D.M.D.

My PCP referred me to Kaiser's sleep clinic, after 6 months of trying to figure out why my heart was acting up. It was her cardiologist husband that suggested I be checked for SA, after all heart exams showed no reason for the near constant PVCs. She admits to being pretty clueless about sleep disorders, and was shocked at my diagnosis. So, yeah, she referred me along to the sleep clinic people, who determined a sleep study was in order.