why a new bipap machine every 5 years

can anybody tell me why the insurance company will only pay for a new bipap machine every 5 years and not like every 2 or three years the reason why I ask is because what if something happens to yours and you need to get a new one with in the 5 year period

Why do you have to depend on your insurance to provide one for you? Buy them out-of-pocket.


Den

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Plus bipaps are very expensive compared to C or Apaps, and they only get changed every 5 yrs. But if something goes wrong, most of us have back-up machines, often older, with lots of hrs on them and not much data available, but they'll get you through times when you're waiting for a new machine to replace your everyday one if it breaks down. And you can get the back-ups through places like Secondwind, or someone here on the forum selling theirs, Craig's List, or just your own one that's been replaced 5 yrs in on your insurance.

springman946 wrote:can anybody tell me why the insurance company will only pay for a new bipap machine every 5 years and not like every 2 or three years the reason why I ask is because what if something happens to yours and you need to get a new one with in the 5 year period

W/o knowing who your insurance is I am willing to bet they will fix or replace your machine if you pass your compliance period and something happens to it.

It used to be 5yrs but now most are saying they will not replace it unless it breaks. Even then it is best to have a backup machine as it can be a week or more before you get a replacement.

For some of that period, you are also likely to be covered under warranty.

There are two concerns: (1) getting a new machine if your old machine is out of warranty, but the insurance company won't pay for a new one yet (2) getting a temporary machine while you are waiting for a new machine to arrive or your old machine to come back from the shop.

This is exactly why people buy a backup machine.

Many of us watch Craigslist or other sources for a good buy on a used machine. For CPAP, I've bought several locally from CL. I often had to wade through a lot of listings at ridiculous prices, but usually found one within a few months. Keep watching and see if you see something that will work. Some people even settle for a lesser machine as a backup as long as they find it cheap enough.

Bilevel machines seems to show up a lot less often than CPAP's.

My own experience has been that XPAP machines have lasted more than five years and are quite reliable. I have been using XPAP's for about 26-27 years and am now have my fourth machine. Only one machine actually failed, and it was about 7 years old when it died. I confess that I have saved my still functioning Respironics BiPAP as a backup, though I doubt that I will ever need it.

TheDuke

not planning on doing anything like this, but had a random thought. if you changed insurance companies, i guess you can get another machine? might have to have sleep study again?

The life expectancy of a cpap is 5-7 years, which is why the 5 year rule. Most insurances are now requiring documentation by the physician of what is wrong with the unit and is it repairable. All cpaps come with a 2 year warranty (some are 3 years) which is why they don't replace at 3 years. Some united healthcare policies will cover every 3 years. Even if you change insurance companies, your new insurance company may not cover a replacement machine if less then 5 years. Some insurances cover a loaner unit and the repair costs to repair your unit.

UHC wouldn't replace or repair my machine, which was purchased by Cigna, until the 5 year mark. I held it together with electricians tape, and slept with a smoke detector mounted on a the wall just above it.

Then, UHC paid for 2 machines in less than 6 months, one a CPAP, one an Auto.

Shows that you cannot predict what an insurance company will do.

Jen

Often, your DME's word the machine is not repairable is all the insurance company needs to authorize a replacement.

I used a Sulllivan IV elite CPAP for 13 years (Sullivan became ResMed). It still works but I'm on BiPAP now so use it to dry my hoses and masks.

Now days, Insurance coverage is more dictacted by the package your company has with an Insurance company that by the Insurance company itself. The company I work for created a package that is administrated by UHC. I have a family member who also has UHC who's policy is quite different from mine even thought the level is called the same. They pay more for their package, have higher co-pay amounts and maximums etc... My co-pay max for in Network is only $850 where theirs was $1500 if I recall correctly.

So while you may have the same Insurance company as someone else, the policy may be different with different limits, restrictions and replacement values. Makes it very hard to compare.

When I asked the Insurance company what the replacement times were for the various billing codes under my policy, I was surprised as it only really had a limit on the machine, which was 3 years. A couple years ago it was 5 years.

Everything else, was basically as needed for tubing, filters, masks etc...
Note that my company self-insures and just has UHC manage the health care coverage.

Will see what the DME is like tomorrow. Company called Valley Respiratory. The alternative was Crapia. Funny thing is their office is literally across the street at the end of the street from my house. Like .25 miles from the house. Never knew they were there.

Theoretically, a blower should be able to last decades.

However, at least up until very recently, the technology and comfort features were all advancing so quickly that getting a new machine every five years just plain made sense.

These days, though, I understand--in this era of penny-pinching (penny wise and pound foolish)--it can be difficult at times for some users to be able to get a new machine paid for by a payer unless it can be established that there is something wrong with the present machine, no matter how old the present machine is. Things seem to be moving that direction, anyway.

Thus the wisdom of finding a gray-market backup in like-new condition to have on standby. Or two.

Wulfman... wrote:Why do you have to depend on your insurance to provide one for you? Buy them out-of-pocket.


Den

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Isn't that a bit like saying "If your car is damaged in an accident, why do you have to depend on your insurance to repair it for you? Pay for it out-of-pocket."?
That's why we buy insurance