CPAP Therapy: Insurance vs Online Purchase?

CPAP Therapy: Insurance vs Online Purchase?

You snore, you toss and turn at night, and you constantly complain of drowsiness the next day. Your doctor sets you up at a sleep lab or a home sleep test and the results are in. You have sleep apnea. You should start continuous positive airway pressure (CPAP) therapy. Now what? Where do you turn? Like most people nowadays, you Google it! The next big question people face related to CPAP therapy: insurance versus online purchase? Hopefully, this article will help with that decision.

The Insurance Route

The first thing to know is that a CPAP machine is durable medical equipment and most insurance companies do cover CPAP therapy. However, the specifics of CPAP therapy insurance coverage may vary by provider and are generally associated with deductibles and copayments.

To keep the costs down for a health care plan, people are increasingly weighing the costs versus benefits. An increase in the deductible typically leads to a reduction in monthly health care spending. In addition, while policy deductibles are rising, insurance companies are reducing the reimbursement rate for medical equipment expenses. For example, even if you have reached your $5000 deductible, a typical insurance plan will only cover 50% of the cost of any durable medical equipment. This includes CPAP equipment.

Common Insurance Scenarios

According to a new report from NPR,1 insurers are tracking through either an SD card or Bluetooth. The data determine if the therapy is adequately used and warrants coverage. The typical usage rate is 4 hours each night. If the insurance’s threshold is not met, they can deny coverage of the machine and the supplies needed for CPAP therapy. Insurance companies counter the increasing number of people diagnosed with sleep apnea by monitoring the CPAP machine, hoses, and masks use.

In another common scenario, insurers are requiring patients to rent the CPAP machines at rates that in total are higher than the retail price of the device itself. This allows the equipment suppliers to make a profit. Because insurance reimbursement has declined steadily over the years, equipment providers find it difficult to operate unless they can extract a monthly fee from the patient.

According to the NPR report, these insurer strategies are part of the industry’s move to shift the cost of commonly used therapies, devices, and tests to the patients. NPR interviewed Dr. Ofer Jacobowitz of ENT and Allergy Associates in New York1 who said that his patients often pay rental fees for a year or longer before meeting the prices the insurers set. But because of deductibles reset in the beginning of the year, they may end up covering the entire cost of the rental.

In nearly all cases, the outright out of pocket expense for supplies would be cheaper without going through insurance.

Online Alternatives

Given the above scenarios, people are increasingly taking a proactive and engaged approach to their healthcare needs. They are conscious of their medical needs, reviewing alternatives and understanding costs for equipment they may need. Many do their own research, discuss products in forums, speak directly with equipment providers, price shop, and buy their own medical supplies.

As you begin your search, you’ll soon see that online suppliers have a larger selection of options and the latest technology available. Your insurer only offers two or three machines or masks. These are typically lower cost models and a limited number of brands. The CPAP Shop, for example, over many CPAP machine and mask options from all the top brands with reviews and expert customer service to guide a purchase. We feature the newest technology designed to fit into your lifestyle.

Need a CPAP machine that fits into the palm of your hand and weighs less than a pound? We have the ResMed AirMini Auto CPAP machine. Or a travel unit that has an integrated battery and a humidifier (coming soon!), the Philips Respironics DreamStation Go Auto is the perfect companion. Need a full-face mask that sits low on the face to allow you to wear glasses or sleep on your side? We have the new ResMed AirFit F30 Full Face Mask. How about a convenient sanitizing machine to get rid of those germs on your CPAP mask? We have the SoClean 2 CPAP Sanitizing Machine.

Do Your Homework

Remember to look for a reputable provider and supplier. Ask if the products are new and review any guarantees or warranties available. Check the company’s website for an address, phone number, and physical location so they can be reached easily. A company that has been around for a while and provides knowledgeable and friendly customer service should give enough confidence to purchase. Call them up and speak with the staff. Customer service should be able to provide product comparisons. They can help determine an optimal choice depending on needs, budget and goals. Ultimately, look for a provider who wants to build a long-term relationship with you versus making a one-time sale.

At The CPAP Shop, we regularly train our staff. They know the newest products to hit the market, the pros and cons of each machine or mask and why it may better suit a particular patient. They can provide the help that you need. We have an on-site respiratory therapist to answer any questions or troubleshoot any problems. The CPAP Shop offers a 30-day risk-free return policy in case the first option what not meeting your needs.

We understand how important the right equipment can be to the long-term compliance with CPAP therapy. Our goal is to make the purchase as easy and convenient as possible, without any hidden costs or data compliance.

Reference:

  1. Allen M. You snooze, you lose: how insurers dodge the costs of popular sleep apnea devices. NPR. https://www.npr.org/sections/health-shots/2018/11/21/669751038/you-snooze-you-lose-how-insurers-dodge-the-costs-of-popular-sleep-apnea-devices. Accessed November 21, 2018.

Chris Vasta is the president of The CPAP Shop and an expert in sleep and respiratory therapy. He often provides insights on product design and functionality on various manufacturers’ prototypes and is frequently tapped to provide reviews on new releases.

Chris Vasta CPAP Expert & President at The CPAP Shop

Author

Chris Vasta

Over a 10+ year career at PHH Mortgage managing a $100 million portfolio, Chris Vasta learned the ins and outs of the business world. He learned how to establish business relationships, lead a multi-prong team, and implement strategies for long-term growth. In 2007, Vasta used that experience to transition his role into president of The CPAP Shop. Over his tenure, Vasta has been involved in everything from website design to warehouse layout. His hands-on approach with customers has evolved into an in-depth understanding of the challenges of beginning and adhering to sleep therapy. He often provides his insights on product…


10 Comments Leave new

  • DeRoy Jensen

    I was diagnosed with Sleep Apnea 20 years ago after an in home analysis. How often should I be tested?

    • Chris Vasta

      That would be a question you would want to ask you treating physician, as it can depend on current/ past health conditions and other variables.

  • Mary Kay

    Why does it seem more expensive to order a cpap machine with insurance than it does if I bought it outright online? I was just quoted $1200 for one with the heated humidifier and all the “first time purchases” but I see the same machine online for $349 without insurance. This is what confuses me and I am a compliant 16yr cpap patient.

    • Chris Vasta

      Our pricing is directly from the manufacturer. Our company is not in-network with any insurance companies, so I am not able to answer questions regarding their costs.

    • Kat Smith

      This is how the sleep apnea clinics make their money. They overcharge the insurance company, plus charge you the remainder that the insurance company won’t cover. Its a win, win for these clinics. Then they tell you that the reason the cost is so high is because they will guarantee it if anything goes wrong. .. however so does the bigger companies that make all these machines. Buy direct it is way cheaper. Then submit the receipt to your insurance company with all your correct medical papers. (prescription from Dr, sleep study your AHI needs to be over 15 to get coverage.) Also anyone buying replacement parts from a sleep apnea clinic you are paying too much. They can be found on line for less than half of what you pay at the clinic. Plus most of the filters are washable so they last longer than what the clinic tells you.

      • Chris Vasta

        Kat, thank you for your feedback. Please note that the requirements and amounts covered may vary among insurance companies, and it is best to check all of your options. The best option may indeed be to pay out of pocket, and then seek reimbursement. If you would like to place an order with one of our customer service team members please reach out to 1-866-414-9700.

  • Jennifer, Sleep deprived

    I was recently diagnosed with mild sleep apnea and I have an underlying thyroid problem and asthma. BCBS is giving me problems and they have refused my claim for the machine. I am writing for the appeal. If they refuse the appeal what is the process to purchase a machine privately? Are there forms that my doctor needs to complete or is there an application that I complete?

    • Chris Vasta

      Hi Jennifer! Our company does not work with insurance, it would be an out of pocket purchase from us. We just require a copy of your prescription signed by your Dr. The prescription needs to state your diagnosis of sleep apnea and what your pressure setting is. The RX can be emailed or faxed to us. You can then place your order online at https://www.thecpapshop.com or you can also give us a call for assistance placing your order. We are open Monday – Friday from 8:30 – 6:30pm EST. We are also open on Sundays from 10 – 4pmEST. Our number is 866-414-9700. Please give us a call if you have any further questions.

  • Donna

    I used to go through a home health agency to receive my supplies when I was first diagnosed. When I ordered filters or nasal covers for example, these items were being repackaged and sent to me. Once I started ordering on line, I received more filters and a complete set of sizes of nasal pillows to try in different sizes with some masks (which was helpful because sometimes I can wear both a small and medium with no air leak). I felt that the home health agency was ripping me off. Since insurance is such a pain to deal with and doesn’t always cover and give you what you need, I have opted to purchase my supplies online. I have found too that I can use the hose and water chamber for my CPAP longer than is recommended. I clean as recommended and don’t feel the need to replace these items ever 3-6 months. I like the freedom to order what I want and need and to try and order masks that my insurance may not cover.

    • Chris Vasta

      Hello, Donna. Our merchandise comes sealed directly from the manufacturer. We are glad to have you as a customer and if you have any questions please don’t hesitate to reach out to our customer service agents at 866-767-9700. If you wanted to submit the claim, the codes are available to submit to your insurance company for a possible reimbursement. https://www.thecpapshop.com/insurance-codes

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