Does My Insurance TRULY Cover My CPAP?

Even though your insurance company may claim to reimburse for these items, the answer is, yes and no.  Some insurance plans, including Medicare, now require that patients starting on positive airway pressure therapy (CPAP, Bi-Level, APAP) have a follow-up appointment with their sleep doctor within 30-90 days of starting PAP therapy.  These rules also state that you must use your PAP unit 70% of nights, for at least 4 hours per night, during a consecutive 30 day period (in the first 90 days) in order to continue receiving insurance coverage for PAP therapy.  Coverage for PAP units will be denied if these requirements are not met and you will be responsible for the cost of your PAP unit and supplies (could be several thousand dollars if purchased through your insurance company or DME provider).  Unfortunately, this happens too often.  CPAP compliance occurs at an alarmingly low rate.  According to Edward Grandi, Executive Director of the American Sleep Apnea Association, compliance only occurs 40-60% of the time, which leaves the patient exposed to covering the cost of their high-priced CPAP equipment and supplies.  If you purchased your CPAP and supplies through one of the reputable online suppliers, without going through insurance or a local DME company, these costs will likely be 50-70% lower.  This often makes more sense for patients who may have insurance coverage, but feel they may not be compliant, have deductibles or co-pays to meet, or don't have insurance coverage.
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