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.
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.
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.
- 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.