Insurance Billing

Mikesus · Post by **Mikesus** » Mon Feb 14, 2005 11:50 am

I am finding it hard to believe that insurance companies are not reimbursing for APAP's. I looked into the billing codes, and they are EXACTLY the same for both units. There is no billing distinction for APAP vs CPAP. Now I can believe that the MAC (Maximum Allowable Charge) might be too low to cover all of it (especially from an overpriced DME). Of course my insurance company won't tell me the MAC, so I get to wait and see...

Dave Hargett · Post by **Dave Hargett** » Mon Feb 14, 2005 12:57 pm

Medicare just reviewed this point of separate coding and decided that there was not enough evidence to show that APAPS worked better than a CPAP (don't have the exact press release in front of me) so it still has the same code.

Most insurance companies follow the Medicare (CMS) codes and reimbursement schedules.

Mikesus · Post by **Mikesus** » Mon Feb 14, 2005 1:22 pm

Dave Hargett wrote:Medicare just reviewed this point of separate coding and decided that there was not enough evidence to show that APAPS worked better than a CPAP (don't have the exact press release in front of me) so it still has the same code.

Most insurance companies follow the Medicare (CMS) codes and reimbursement schedules.

So are you saying that as far as billing is concerned they are the same?

snoozin' · Post by **snoozin'** » Mon Feb 14, 2005 2:26 pm

Yes, as far a s billing is concerned, they are the same. If you submit the bill to your insurance company, they will not care if it is apap or cpap - they will pay the same amount for either. If you buy online, your apap cost is probably still less than the cpap cost through a DME.
Debbie

Guest · Post by **Guest** » Mon Feb 14, 2005 2:58 pm

snoozin' wrote:Yes, as far a s billing is concerned, they are the same. If you submit the bill to your insurance company, they will not care if it is apap or cpap - they will pay the same amount for either. If you buy online, your apap cost is probably still less than the cpap cost through a DME.
Debbie

That is what I thought. I checked for that billing item and got a figure near $1000 so I shouldn't have a problem... Too bad they don't cover the software For me that is a compliance necessity!

johnnygoodman · Post by **johnnygoodman** » Mon Feb 14, 2005 3:17 pm

Howdy,

This is why cpapforseniors.com was created!

We wanted to be able to give patients a method of getting the good stuff. Also, we wanted them to be able to choose which good stuff was best for them. It's true though, if we vended plain CPAPs instead of Autos, we'd be paid the same. These kinds of oddities are typical of a government run system.

However, we've decided to take a lower profit, work on being efficient, and give the customers the choice. It's moral and our previous experiences have taught us that pleasing customers almost always finds it's way to a companies bottom line.

Mikesus · Post by **Mikesus** » Mon Feb 14, 2005 3:53 pm

johnnygoodman wrote:Howdy,

This is why cpapforseniors.com was created!

We wanted to be able to give patients a method of getting the good stuff. Also, we wanted them to be able to choose which good stuff was best for them. It's true though, if we vended plain CPAPs instead of Autos, we'd be paid the same. These kinds of oddities are typical of a government run system.

However, we've decided to take a lower profit, work on being efficient, and give the customers the choice. It's moral and our previous experiences have taught us that pleasing customers almost always finds it's way to a companies bottom line.

Not a senior yet, but I do have my "Senior Moments"

My point was folks seem to be worried that ONLY CPAP will be covered and I have seen some posts implying that APAP's are NEVER covered. I can't imagine this happening as the billing code is the same...

jdschooler · Post by **jdschooler** » Tue Feb 15, 2005 4:09 pm

My DME said that BC of ND will cover my APAP....atleast they better or I am going to have a big bill I didn't expect.