Insurance / No Insurance

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Insurance / No Insurance

Post by PhotoCrusader » Wed Dec 06, 2017 11:34 pm

After more time and calls and conversations, my CPAP may not be covered by my medical insurance. My husband's HR manager is going to see what she can do. There appears to be a an insurance rider that they didn't include / know about. So, CPAP is on hold. I am going to look into getting it on my own. I am working on getting my CPAP prescription from my doctor. Does anyone know of any good (but not so expensive) companies that sell CPAP equipment? I am located in the Santa Clarita Valley in Southerrn California (Los Angeles suburbs).

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Re: Insurance / No Insurance

Post by CRMW » Wed Dec 06, 2017 11:44 pm

The online providers are the cheapest. You can start with our host. CPAP.COM

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Re: Insurance / No Insurance

Post by PhotoCrusader » Thu Dec 07, 2017 12:02 am

CRMW wrote:The online providers are the cheapest. You can start with our host. CPAP.COM
This will be my first CPAP. Don't I need a fitting and instruction?

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Re: Insurance / No Insurance

Post by zoocrewphoto » Thu Dec 07, 2017 2:21 am

PhotoCrusader wrote:
CRMW wrote:The online providers are the cheapest. You can start with our host. CPAP.COM
This will be my first CPAP. Don't I need a fitting and instruction?

What kind of study did you have for the diagnosis? Did it determine plain obstructive sleep apnea? If so, you should be fine with an auto cpap machine. We can help you with some starting settings and then you can dial it in to what works best for you.

Masks are more of a challenge since it helps to try them on and see how they feel. But even then, it can be hard to tell what will work well. offeres return insurance, some free, some cheap, depending on how popular the mask is. So, if you don't like it, you get most of your money back.

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Re: Insurance / No Insurance

Post by Pugsy » Thu Dec 07, 2017 4:55 am

Call some of the local brick and mortar DME stores in your area that sell cpap and tell them the machine you want and ask them their price for no insurance involved purchase. Call specific about the machine that you want and that you will be buying either online or from the DME who will maybe match the online prices. Don't let them try to deflect you to a different cheaper machine.
Sometimes DMEs will price match or come real close to online prices to get a sale. That way you would have them for mask and fitting issues that you might need initially if this is a real big concern to you.

Also ask what their mask swapping policy is. Some will allow one swap within 30 days...some will allow no swaps...some will allow many swaps because the mask manufacturers all have a 30 day return thing so DMEs won't lose money if a mask doesn't work out and they have to swap it out.
You want one that will allow many swaps within a 30 or 60 day time frame of getting that first mask.

That's the masks that would most likely require the DME "fitting"...the machines are easy to setup and use. It's the finding of the right mask that is often the hardest part.

Decide on which machine you want...brand and model and don't let price be the deciding factor if at all possible because getting a good data capable machine up front is really important since you want to be able to monitor the effectiveness of your therapy yourself.
Get a machine that uses a SD card for data storage and has the ability to auto adjust the pressure if needed. You may or may not actually need or do better with an auto adjusting pressure mode than with a fixed pressure mode but it is better to have it and not need it than need it and not have it. We call the machines that have the auto adjusting mode available APAPs but in reality they are cpaps with both fixed cpap mode and auto adjusting apap modes available. 2 machines in one and in some cases 3 machines in one.

Did you have a sleep study titration where you were put on a machine to find out what pressure you need?
If so...what was that pressure? It helps in deciding which brand and model might better suit your needs.

If you didn't have a sleep titration study....I would target ResMed because if you do end up with higher pressure needs I think the exhale pressure relief available is a bit superior to Respironics when pressure needs are over 10....just my personal opinion but I have used both Respironics and ResMed APAPs and I speak from experience.

Was your diagnosis plain ordinary obstructive sleep apnea? This is important to know. If your diagnosis was complex or you had a large number of centrals then apap might not be the best choice and instead you would maybe need something else that can better deal with the centrals.
A few centrals not a big deal...but a lot of centrals could be a big deal. Most people have plain jane vanilla OSA.

Assuming you have plain jane vanilla OSA and no problem with centrals...then look at these machines.
ResMed... The AirSense 10 AutoSet for Her (it's 3 machines in one) or the AirSense 10 AutoSet (2 machines in one).
The for Her model has a special apap mode that sometimes suits some people better (male or female actually but target marketed towards women). Most people won't need that special mode though.
Respironics...the DreamStation Auto CPAP (2 machines in one)

now sometimes good deals can be found on the slightly older prior discontinued models of these 2 brands...but local DMEs probably will not have those discontinued models in stock.

To give you an idea as to what you can find online and the price here is the ResMed AirSense 10 AutoSet....I couldn't find a for Her model at this time but one might show up later. ... 10+AutoSet

or the Respironics DreamStation Auto CPAP and this price includes humidifier ... eamStation

There's nothing stopping you from getting your machine online and using a local DME for masks if the DME will just do it.
These machines aren't hard to setup.
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Re: Insurance / No Insurance

Post by grayghost4 » Thu Dec 07, 2017 10:33 am

If you're not part of the solution you're just scumming up the bottom of the beaker!

Get the Clinicians manual here : ... tup-manual

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Re: Insurance / No Insurance

Post by ChicagoGranny » Thu Dec 07, 2017 12:43 pm

PhotoCrusader wrote:After more time and calls and conversations, my CPAP may not be covered by my medical insurance.
Part of the "bible" for insurance is HCPCS codes. The code for a CPAP machine is E0601. Maybe this makes it easier for your HR rep to talk to the insurance people.

There are also codes for masks - ... -page.html

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Re: Insurance / No Insurance

Post by FishLips » Mon Dec 11, 2017 3:33 pm

Don't sweat it. Honestly, I see little point in using insurance on CPAP stuff unless you've hit your deductible. Of course, it's a no-brainer if you've hit our out-of-pocket max though. I've bought 3 machines in the last 3 years and lots of supplies.

Machine (ResMed Autoset 10 (for her)):
I bought the first machine through insurance. It was like $1600. $178/mo for 9 months. After the deductible, my portion (20%) would have been $320. Of course, it didn't work that way because I hadn't hit my deductible through some of those payments, making my portion closer to $900.

The 2nd machine (for my ex-wife), I bought from because it was the first medical purchase of the year and it would have cost considerably more going through the DME. It was right around $875. No insurance.

3rd machine (for my girlfriend). Check your local classifieds/craigslist/ksl (in UT/ID). There are ALWAYS brand new machines available for a fraction of the new cost. I just bought a brand new machine with 0 (zero) hours for $350.

ridiculously priced through the preferred DMEs - only worth it if you have good insurance and have hit your deductible. I watch ebay, but the prices usually aren't low enough to justify purchasing over the stuff at (they offer a return policy). Same with hoses and parts.

Filters and cushions:
Deals are to be had on ebay or classifieds - usually right around what they'd cost me post-deductible through insurance.

Instructions: Get them here. You're ahead of the curve.

Fitting: Depends where you are. A local DME may let you test fit them. IHC in Utah would. While you're there, ask if they can offer you a cash price. Keep your phone handy, and compare the price they give you with that of

As always, YMMV.


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Re: Insurance / No Insurance

Post by chunkyfrog » Mon Dec 11, 2017 4:28 pm

Many insurance companies are trending toward deductibles so high,
they are worthless except for major medical.

Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backup: Devillbiss Intellipap Autoadjust
I once was lost in apnea; but now I'm found--breathing easily all night long.
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Re: Insurance / No Insurance

Post by Hoot » Tue Dec 12, 2017 11:44 pm

bought my cpap through which was cheaper than going through an in-network provider through my medical insurance. has a large selection of machines. The in-network provider only had three overpriced machines to choose from.