Will my insurance pay for CPAP/BIPAP?
CPAP is covered under a benefit call Durable Medical Equipment (DME). Most insurance companies provide a DME benefit, but often, the deductible for the calendar year must be met before the insurance will pay. Depending on the amount of your deductible, you may have to pay for the entire cost of therapy. Your insurance company or CPAP supplier (DME company) should be able to provide this information for you.
Do I need prior authorization for my CPAP/BIPAP?
Many insurers require prior authorization before you receive a CPAP/BIPAP. Your DME or insurance company can determine this.
My mask doesn’t fit; when can I get a new one?
You should be able to get a new face mask every 90 days. You can get a mask sooner if the style is different (i.e. from full face to standard nasal). Some DME companies have demo masks that you can try before you buy. Some (not all) have a replacement program for new CPAP/BIPAP users that will replace a poorly fitting mask if they are notified within 30 days.
How often can I get new supplies?
Filters, mask cushions/nasal pillows– two items every 30 days
Masks and tubing – every 3 months
Headgear, humidifier reservoirs, chinstraps – every 6 mo.
This is a fairly standard replacement schedule most insurers follow. Some insurers will allow for a shorter mask replacement schedule during the first 90 days to improve compliance.
Why do I have a card/chip in my CPAP?
The card contains information on your use of CPAP, as well as other information that your sleep provider can use to determine the effectiveness of your therapy. Your insurance company will use the information to determine how compliant you are with therapy. They will determine whether or not to pay for your CPAP based on this information. Compliance is generally considered to be at least 4 hours per night, at least 70% of nights in a 30 day period. Most insurers will give you at least 90 days in which to achieve this goal.
When will I own my CPAP?
Most insurance companies require a rental period, but not all.
MEDICARE- purchase after 13 months of continuous rental.
BLUE CROSS- client choice- must rent for the 1st month.
PROVIDENCE- immediate purchase after successful trial.
PACIFIC SOURCE- purchase after 3 months of rental.
ODS- purchase after 12 months of rental.
Other Insurers- depends on the plan. Check with your DME company.
Can I choose my Durable Medical Equipment Company?
Yes, BUT- some insurance companies have contracts with DME companies. If you go out of the network, you may have financial consequences, such as higher co-pays and deductibles.
Does my CPAP have a warranty?
Most CPAPs have a 2-year warranty; most BIPAPs; one year.
When am I eligible for a new CPAP?
CPAPs can be replaced no sooner than 5 years from the set-up. New units will be provided for those moving from one type of therapy to another (CPAP to BIPAP). A non-functioning, non-repairable unit may also be replaced.
Will insurance companies provide a CPAP with new features?
Most insurers will NOT reimburse on a new CPAP because of new features, new technology, size of CPAP or noise level unless it has been over 5 years from the last set-up. Simply having a physician’s order for new equipment does not ensure that your insurance company will pay for it.
