Are CPAP Machines Covered by Insurance?
  • 10 Jun 2022
  • 4 Minutes to read
  • Contributors
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Are CPAP Machines Covered by Insurance?

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By Susan - Certified Sleep Science Coach

Will Insurance Cover My CPAP Costs?

The answer to this question could be yes and no based on your insurance and at what costs to your health. They may cover your CPAP, but chances are you will need to meet requirements before getting your therapy, and that could lead to lost sleep.

What are some of those requirements? Let’s take a closer look.

  • You may need prior authorization to receive your CPAP machine; check first.
  • You will need to have a face-to-face appointment with a physician or sleep doctor, and you will need this every year for most insurance and Medicare.
  • You will also be required to stay compliant proving that you are using your device at least 4 hours a night for continuing insurance coverage.
  • After seeing your doctor, you will be required to take a sleep study, and you may have to do that in a sleep lab environment rather than taking the simple at-home sleep study.
  • You will probably need to meet certain criteria and have an AHI between 5-14 with such comorbidities as hypertension. Your sleep study will determine your AHI

If you skip any of these steps, you may have to start all over again.Keep in mind that as you go through these steps, you continue to lose valuable sleep. 

Once you have completed the requirements and been approved for CPAP therapy, do not assume that your insurance will cover most of the costs. Check to see what they will and will not cover, as not all insurance providers are the same.

It is advised that you contact your Insurance provider prior to billing your claim. Most insurance companies will cover the cost of your CPAP/BiPAP machine and supplies with appropriate documentation. Some Insurances will not accept paper claims and therefore will only accept an electronic claim. Be sure to confirm with your insurance company these questions.

Here are a few questions to ask your provider:

  • May I purchase the CPAP machine and still have it covered? 
  • Is Respshop in network or will I be paying out of pocket for this claim? 
  • Is pre-authorization required? 
  • Do you accept a paper claim? 
  • What documentation will I need to send with my claim? 
  • Will I need to add any modifiers to my claim? 
  • What percent of the cost of the CPAP equipment is reimbursable? Most only cover a portion of the cost so be sure to ask and never assume.
  • What deductible or co-pay amount must be met before I am eligible for any reimbursement?
  • Will I get a new machine? Not necessarily - again, be sure to ask.

What Are My Options?

While deciding if you should go through insurance, consider also the time and the cost. Here is what you will need to purchase or rent a CPAP device without going through insurance or Medicare.

You will need a sleep study, and you can either get that in a Sleep Clinic OR use a *Home Sleep Study. Feel free to read this article on Home Sleep Testing.

You will need to have a valid prescription from a physician, and it does not need to be a sleep doctor.

Once you have your prescription, you are free to purchase a device from any durable medical equipment (DME) provider.

And that is all.

How Does Respshop Take Care of Me?

We have a professional staff of Respiratory Therapist, Polysomnographic Techs, and a Licensed Practical Nurse all here to help and support you every step of the way. 

You could be sleeping soundly within a week if you already have your script. If not, no problem. We have partnered with dedicated sleep physicians that will send you a home sleep study.

They will also provide an online appointment where they will go over your results, and you can ask questions. They will email you the link to your online appointment, and all you need to do is follow the instructions.

It’s that easy!

Once you have your script, all you need to do is follow up with our staff to help you decide which CPAP device and supplies you need. Orders are shipped the same or next business day.

If you are worried for any reason about CPAP therapy, I understand your concerns because I am also a CPAP user and would not go back to sleepless nights. 

I did not even realize I was not sleeping enough until I started therapy. And now, I wake up only once a night.

Once you have purchased your device from Respshop, the service does not stop there. You can choose to have us follow your treatment and help make recommendations based on your sleep data. 

If you need to have your pressure changed, we can do that, too, with a new prescription. No need to bring the machine to your physician for adjustment as we can do it remotely, according to your new prescription.

You could schedule an online appointment with our partnered sleep physicians for a nominal fee or see your own doctor for that RX.

We do provide insurance forms that you can fill out and give to your insurance company to see if they will reimburse you, but we suggest you check with them first, and we don’t guarantee payment.

*Clinical Lab sleep study is recommended for those with High-Risk Sleep Apnea or certain medical conditions. You may want to discuss this with your physician before doing a home sleep study.

What Respshop Offers

  • A team of medical professionals
  • Online Physicians and a Sleep Study
  • Data reporting and consultations
  • Same day or next day shipping
  • Mask Assurance reasonable return policy

We want you to have the best possible experience and get the rest you need.

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