Issues with insurance not paying for CPAP software

[WayUpNorthInAlaska]

Just curious if anybody else has had problems getting insurance to pay for the SmartLink sleep-tracking software package for the DeVilbiss IntelliPap AutoPap machine. I have submitted the claim a half-dozen times so far, but my insurance company (CIGNA/Great-West Healthcare) says only $6 of the $149.95 cost is an allowable charge (and it took the fifth claim to get them to even show an allowable charge). I have submitted a doctor's prescription for CPAP machine/supplies, an official "letter of medical necessity" required for all medical supplies, and a personalized note from the doctor, but still haven't been able to get this item to show up as an allowable charge. My insurance company says the item code being used by US Expeditors/CPAP(dot)com shows up as a miscellaneous item and not a typical CPAP supply (masks, filters, hoses, etc.), which is one reason this claim hasn't gone through. I couldn't afford to buy this as part of the bundle when I bought my machine and humidifier, and I needed to get another paycheck before I could order this item. I live in a remote island community, so this software is the best way I can track my sleep patterns since there is no sleep testing center nearby. Has anybody else had to deal with insurance issues for this item? I haven't had these problems with other CPAP supplies, just this software.

[Wulfman]

Your situation is typical. Insurance does not pay for or reimburse for the monitoring software......PERIOD!
In the last five years, I've only seen about two instances of where the user slipped it through somehow.

Don't feel alone......I tried about five years ago, too.


Den

[Slinky]

Yup, yup, frequenting 4 apnea support forums for 3 1/2 years now and I've only ONCE read where someone's insurance paid for the monitoring software. Wulfman's comment is the first I've read where a second person was able to get their insurance to pay for the software. I've gotta give you credit, tho, for perseverence!!!

[Wulfman]

Yup, yup, frequenting 4 apnea support forums for 3 1/2 years now and I've only ONCE read where someone's insurance paid for the monitoring software. Wulfman's comment is the first I've read where a second person was able to get their insurance to pay for the software. I've gotta give you credit, tho, for perseverence!!!

That's only because I've been around here just a tad bit longer than you have.......

Basically, there's no insurance code for it (or one they're willing to recognize as valid).


Den

[magicland]

Heck, I'd be happy just to get them to pay for the CPAP. Unfortunately, just about all insurance companies fail to see the software as "necessary" to your therapy. As long as you're in compliance, they're happy, whether or not you're actually receiving any benefit from it or not.

[cpapqueen1]

you get some efficacy data off that unit without the extra gizmo by utilizing the devilbiss website.

[WilsonVilleUSA]

I've had software/reader covered with no problems on two different machines over the years. First for my Encore Pro and then for the Sandman Therapy software.

My employer is self-insured and uses Aetna to manage the plan. Both times the purchase was through cpap.com, and I believe I used the "misc" E1399 billing code when making my claim for reimbursement on one and on the other it was part of a machine/software package and since the cpap.com prices are so low compared to insurance allowables, even with the software included the total price was within the allowable for a CPAP machine under the E0601 code. I just paid my 20%.