Are CPAP Machines Covered by Insurance?

By Susan – Certified Sleep Science Coach Does Insurance Cover CPAP Machines? The answer to this question is: it depends on your insurance. Insurance plans that do cover a CPAP typically covers a new CPAP machine every 5 years. Travel CPAP machines are usually not covered. In addition, insurance providers have many requirements that need to be […]

Does Insurance Cover CPAP Machines?
What Are My Options?
How Does RespShop Take Care of Me?
What RespShop Offers

By Susan – Certified Sleep Science Coach

Are CPAP Machines Covered by Insurance?

Does Insurance Cover CPAP Machines?

The answer to this question is: it depends on your insurance. Insurance plans that do cover a CPAP typically covers a new CPAP machine every 5 years. Travel CPAP machines are usually not covered. In addition, insurance providers have many requirements that need to be met. Let’s take a closer look at these requirements.

Requirements for CPAP Machine Insurance Coverage

  • You may need prior authorization to receive your CPAP machine. Always check with your provider 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. Some insurance providers require you to take an in-lab sleep study instead of a more convenient 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.

Are CPAP Machines Covered by Insurance?

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 Therapists and Polysomnographic Technologists to support you every step of the way. You can be sleeping soundly within a week if you already have your prescription. If you don’t have a CPAP prescription, that’s no problem either. RespShop is partnered with board certified sleep physicians who offer home sleep testing, interpretation and CPAP prescription services.

All of our Prescription Assistance Services are done online for your convenience. Simply select the service you need and book an appointment time. You’ll receive an email with a link to your online appointment and if you choose to do a home sleep apnea test, you’ll get the testing device in the mail. It’s that easy!

After your appointment, you’ll receive your CPAP prescription by email. Once you have your prescription, you can go ahead and buy a CPAP machine. If you have questions about choosing a machine, the RespShop team is here to help you decide which CPAP device and supplies you need. We’ve worked with a lot of CPAP patients and can provide CPAP mask and machine recommendations. We also ship orders the same day (if placed before 3pm PST) or the next business day so you can start sleeping better as soon as possible.

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.

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
  • 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.