As a CPAP machine supplier, one of the most common questions we receive from our sleep apnea patients is this: what do I do if my insurance will not cover my CPAP equipment? While frightening, unfortunately, this dilemma is common.
Several different medical and financial circumstances can cause your insurance not to cover the cost of your CPAP mask and machinery. While paying the expenses of your sleep apnea therapy can be intimidating, we're here to help. In this blog, we're sharing our expert guide on what to do if insurance won't cover your CPAP equipment. To learn more, keep reading.
What Are the Costs of My CPAP Equipment?
Before we can dig into why your insurance may not agree to cover the cost of your CPAP supplies, we should outline what the exact prices of your equipment are. Total CPAP supplies can look different for anyone depending on their specific condition. However, the primary equipment needed for CPAP therapy are as follows:
- CPAP mask
- CPAP machine
- Travel CPAP equipment
- CPAP cleaning supplies
Each of these supplies is essential for keeping your machinery functioning efficiently and effectively so that you can sleep peacefully with enough airflow each night.
Unfortunately, while many insurance companies supply masks, machinery, filters, tubing, and headgear to CPAP patients, smaller supplies are sometimes not covered.
Insurance and Reorders
Oftentimes, the more considerable expenses of CPAP therapy equipment are not the machinery itself, but the chronic reorders needed for filters, tubing, and other pieces of equipment. In order to keep CPAP equipment functioning properly, it's critical to regularly maintain and order new filters and supplies to keep this machinery running.
If your insurance will not cover your CPAP equipment, or your insurance does not cover the cost of reorders for these supplies, there may be several reasons why.
Why Won't My Insurance Cover My CPAP Equipment Costs?
Before looking for alternative options for your CPAP coverage, it's crucial to review why your insurance may have refused coverage.
Understanding why your insurance will not provide coverage can help you determine how to meet some of these requirements. Review some of these common reasons for denied CPAP equipment coverage and their solutions below.
Unfortunately, most standard insurance allowances for CPAP replacements and the recommended replacement schedule for CPAP therapy do not work in tandem. In fact, many insurance companies only allow one new replacement CPAP mask and supplies once every couple of months.
While these replacements are helpful, DME technicians often advise patients to replace their CPAP equipment on a more frequent and regular schedule than the number of available insurance allowances.
Since neglecting to replace CPAP equipment significantly affects its functionality, many patients have no choice but to exceed their yearly allowances for replacements.
Exceeding your insurance allowances for replacements can be incredibly frustrating. While there's no guaranteed approach to fixing this problem, speaking with your health insurance company can help.
When you talk to a member of your health insurance company, express your concerns about replacing your equipment to stay compliant with your CPAP therapy. Although speaking individually to your health insurance does not always change your coverage, sometimes this step can be highly effective.
Another possible solution to this insurance issue is to clean your CPAP equipment more regularly. The better you maintain your CPAP equipment, the fewer replacements for tubes, filters, and headgear you'll need.
One of the most common reasons that sleep apnea patients do not receive insurance coverage for their CPAP equipment is CPAP compliance. This is because CPAP compliance plays a rather significant role in insurance companies' CPAP equipment coverage.
In general, CPAP compliance is a measurement of how often you use your CPAP equipment. Therefore, the more often a patient uses their equipment and keeps their CPAP machine well maintained, the better their CPAP compliance score will be.
You cannot receive insurance coverage for your CPAP equipment without demonstrating CPAP compliance. The standards for meeting compliance differ depending on your insurance company. However, the most common compliance expectation is that patients use their machines four hours every night for a consecutive month.
If you have not demonstrated compliance with your insurance company, here are some possible solutions.
If you're deemed non-compliant and denied insurance coverage for your CPAP equipment, the best solution for this dilemma is to speak with your doctor and your DME technicians. Most often, patients are non-compliant because there is an issue with their sleep therapy.
For example, if you remove your mask due to congestion in the middle of the night or experience claustrophobia, your doctor and technician can help find equipment that fixes these issues. As a result, not only will your sleeping experience be more comfortable, but you'll have a better chance of being approved as compliant.
What Are My Options Outside of Insurance Coverage?
You're not alone if you cannot rely on your insurance to cover your CPAP equipment costs. Unfortunately, many patients do not have any insurance coverage for their CPAP equipment. Other patients cannot find the equipment they need under their DME insurance options. Luckily, CPAP equipment suppliers are available to work with you personally to figure out financing options.
In fact, buying your CPAP equipment online can ultimately save you money. Since online CPAP suppliers only require a prescription, they do not need to work closely with insurance companies and billing. Without insurance restrictions, patients also have more machinery options available.
Realizing that your insurance will not cover your CPAP equipment can be terrifying. However, we hope this guide shows you some simple solutions to working with your insurance company and opting for online suppliers.
Don't panic if you're wondering what to do if insurance doesn't cover CPAP equipment; don't compromise your health or wellbeing because of insurance or financing concerns. If you need help navigating how to finance your CPAP supplies and machinery, contact our team at CPAPnation for assistance.
We dedicate ourselves to helping our customers find the best medical equipment to achieve maximum comfort. To learn more about our machines and services, explore our CPAPnation website.