Insurance Companies

[oklajohn]

Please help me understand what the term "insurance company" appearing in many posts refers to? Do you have to take out insurance when you purchase a Cpap? Or is it in reference to Medicare/Health Insurance coverage. I haven't found an answer for this by reading posts, googling, or FAQ's. Help!

[Janknitz]

Medicare, Medicaid, and some health insurers have Durable Medical Equipment coverage (DME) which pays for the sleep study, CPAP machine and supplies, minus deductibles and co-payments. Some people have a good Medicare supplement plan (Medi-Gap) that covers those deductibles, occasionally with low or no co-payments. People on Medicaid pay very little, if anything. It is the rare person who has private medical insurance that pays 100%.

In any case, when someone else is paying (Medicare, Medicaid, private insurance) they get to dictate, what is covered, and what the criteria is for coverage. That's what people are referring to if they are discussing insurance coverage for CPAP and supplies.

[oklajohn]

Thanks, Janknitz for the reply. And for your informational urls. I have Medicare with Blue Cross Federal Employees supplemental insurance, and My DME is run by a local hospital - Integris Medical Center - so I should be in fairly good shape. But, I appreciate your warnings about what can happen.

[Okie bipap]

Medicare will cover machines, masks, cushions, nasal pillows, head gear, hoses, filters, water reservoirs. They do not cover batteries or any sort of supplemental power back up systems.

[oklajohn]

Thanks Okie bipap

[Pugsy]

Here's a list of what Medicare will pay for in cpap supplies along with the replacement allowance time frame.
Please note that this is just the replacement allowed time frame...it's not when Medicare says you should replace anything.
In fact Medicare doesn't want you replacing something unless it no longer functions like it should.
Auto shipments to Medicare patients are against the law.
The patient is supposed to request the item.
Only thing that might be iffy in this list is the 5 year thing for a new machine. Medicare now wants the machine to be non repairable before it will pay for a new machine no matter how old it is.

Filters are indeed covered.....back up batteries are NOT covered.

[squid13]

I have Medicare and Federal Blue Cross/Blue Shield and have never paid for anything since I've been on Cpap.

[zonker]

I have Medicare and Federal Blue Cross/Blue Shield and have never paid for anything since I've been on Cpap.

including that drink in your hand? (i mean tentacle)

[squid13]

I don't drink, and what is that remark suppose to be. It was made to show oklajohn that I have the same insurance coverage as him and give him an idea of his coverage.

[zonker]

I don't drink, and what is that remark suppose to be. It was made to show oklajohn that I have the same insurance coverage as him and give him an idea of his coverage.

your avatar has a drink in it's tentacle is all.

[oklajohn]

Appreciate all the info provided. Sounds like if I watch things closely, I should be ok, reimbursement-wise.

[squid13]

OK

[clownbell]

@oklajohn - FWIW, I am on Medicare and pay 20% of the cost of all covered supplies. I typically pay about $30-$40 per calendar quarter depending on items ordered. The thing is - - you may not need to replace as often as Medicare allows. For example, the water tub is 1 year old (vs Medicare replacement time frame of 6 months) and it works just fine. I do have backups on hand for most everything, just in case something goes sideways. Murphy's Law. And Murphy has friends everywhere.