It's my understanding that CPAP devices cannot be purchased without a doctor's prescription or doctor's recommendation. Is that correct? I curious about that because when I go over to CPAP.com, it seems like you can just order their stuff over the internet, and they don't seem to have any way of checking whether you have a doctor's prescription for it, or a diagnosis or anything.
Also, from what I understand, my insurance pays for the rental of my CPAP and mask. But what if I decide to go with something I see on the internet? How do I get my insurance to pay for that? Should I just go through the same sleep diagnostic center that issued me my CPAP to try and get the kind that I want?
Choosing the right mask and insurance coverage.
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CollegeGirl
- Posts: 1038
- Joined: Thu Oct 20, 2005 6:49 pm
- Location: VA
Tarzan,
cpap.com does indeed require a prescription before they will sell a CPAP machine to you. Not sure how you get it to them (fax or snail mail, I would imagine), but they do require one. Someone who has bought one this way will chime in and tell you, I'm sure. Masks and accessories, however, *can* be purchased without a prescription.
As to whether your insurance company will pay for machines/masks purchased online, you have to check with them. Some will, some won't.
If they won't pay for online purchases, then go to your DME (Durable Medical Equipment provider). That can sometimes be the sleep center that diagnosed you, but is usually not. Then ask what your copay on the machine you want would be. If it's more than it would cost you to just pay cash for it online, just buy it online, and save yourself the hassle of dealing with the insurance/DME at all.
cpap.com does indeed require a prescription before they will sell a CPAP machine to you. Not sure how you get it to them (fax or snail mail, I would imagine), but they do require one. Someone who has bought one this way will chime in and tell you, I'm sure. Masks and accessories, however, *can* be purchased without a prescription.
As to whether your insurance company will pay for machines/masks purchased online, you have to check with them. Some will, some won't.
If they won't pay for online purchases, then go to your DME (Durable Medical Equipment provider). That can sometimes be the sleep center that diagnosed you, but is usually not. Then ask what your copay on the machine you want would be. If it's more than it would cost you to just pay cash for it online, just buy it online, and save yourself the hassle of dealing with the insurance/DME at all.
I agree with CollegeGirl
I will add also
Check to see if you insurance pays for rental or rent to buy. Check your copay if it is truly rental and see how long before you rack up enough copays to own your own.
Also check to see what level and brand of machine your are getting for those copays.
In my case I got my machine for $280 out of pocket vs $709 cash with no insurance (my insurance won't let me buy online). But that is with a 20% copay. There was someone here recently with a 50% copay and the machine was cheaper buying on-line with no insurance.
I really doubt that you mean your insurance pays for a mask rental. That is usually a purchase. Again prices vary with DME's and you want to make sure your copay isn't more than a cash/no insurance purchase. An additional thing to consider is being able to see the mask and possibly try it on before buying. Might be able to do this at a local DME but not always.
Some of us are lucky enough to have been given the mask from our sleep study. Or if not, were able to write down what it was if we liked it. So if we choose to order online we know what we like and what fits.
You have to do the researche with your own insurance and your own DME choices (local or online like Bill-my-insurance.com or cash with CPAP.com)
Some people here are lucky and have 100% coverage. So it is no one-answer-fits-all situation.
I will add also
Check to see if you insurance pays for rental or rent to buy. Check your copay if it is truly rental and see how long before you rack up enough copays to own your own.
Also check to see what level and brand of machine your are getting for those copays.
In my case I got my machine for $280 out of pocket vs $709 cash with no insurance (my insurance won't let me buy online). But that is with a 20% copay. There was someone here recently with a 50% copay and the machine was cheaper buying on-line with no insurance.
I really doubt that you mean your insurance pays for a mask rental. That is usually a purchase. Again prices vary with DME's and you want to make sure your copay isn't more than a cash/no insurance purchase. An additional thing to consider is being able to see the mask and possibly try it on before buying. Might be able to do this at a local DME but not always.
Some of us are lucky enough to have been given the mask from our sleep study. Or if not, were able to write down what it was if we liked it. So if we choose to order online we know what we like and what fits.
You have to do the researche with your own insurance and your own DME choices (local or online like Bill-my-insurance.com or cash with CPAP.com)
Some people here are lucky and have 100% coverage. So it is no one-answer-fits-all situation.
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Guest
I'll give you my answer. It will mostly mirror what the others have said.
For anything to be covered through an insurance company, a doctors prescription will be required. CPAPs, Bi-Levels and related supplies are catagorized by the FDA as Medical Devices, so they all require a prescription even if you don't go through an insurance company.
Most insurance companies will rent a cpap for 1-3 months and then convert to a purchase. (This is to ensure compliance before buying the unit)
Some will rent for a full 15 month cycle and then have an option to covert to purchase (What's called a 'Capped Rental').
Some will purchase the units right from the start.
Masks, tubing, and other supplies are always a purchase as they are considered Single Patient Use by the FDA.
When price shopping bear in mind that if you go through your insurance company - the price will be the same no matter where you go. Various DME providers or the internet will all be the same as the price is determined by your insurance company, not the provider.
When checking cost through your insurance, make sure you are determining your price off the allowed amount, not the submitted amount. The insurance companies will only pay a portion of the charge submitted by a provider, so they allow a payment of $800.00 for a cpap, the amount submitted may need to be $1500.00 or more depending on the insurance. Your copay will be based on the allowed amount except in extremely rare circumstances where an insurance company has very poor DME coverage (Aetna is the most common where this is seen).
If paying cash, the price may vary wildly. Find a company that does not bill insurance to find the best price. Federal Law does not allow a company that bills Medicare to offer a lower price for a cash customer, so you will not find a lower price going through most DME providers.
To get your insurance to cover the cost of the equipment and supplies, have your doctor or sleep lab send a copy of your sleep study and the prescription to the provider you have chosen. Most Sleep Labs and doctors will do this for you automatically as this is the standard practice for these procedures.
Typically, when you go in for a sleep study they will ask you beforehand if you need a CPAP if you have a preference for a provider. If you do not, they will generally have several they work with that are in-network with all the common insurance companies. If you need a CPAP then in the morning they will send a copy of the sleep study to your doctor and to the DME provider. The DME will then obtain authorization from your insurance. The doctor will review the sleep study and sign a prescription and provide this to the DME company who will then contact you to setup either delivery of the equipment to your home or a meeting in thier facility to set you up.
For anything to be covered through an insurance company, a doctors prescription will be required. CPAPs, Bi-Levels and related supplies are catagorized by the FDA as Medical Devices, so they all require a prescription even if you don't go through an insurance company.
Most insurance companies will rent a cpap for 1-3 months and then convert to a purchase. (This is to ensure compliance before buying the unit)
Some will rent for a full 15 month cycle and then have an option to covert to purchase (What's called a 'Capped Rental').
Some will purchase the units right from the start.
Masks, tubing, and other supplies are always a purchase as they are considered Single Patient Use by the FDA.
When price shopping bear in mind that if you go through your insurance company - the price will be the same no matter where you go. Various DME providers or the internet will all be the same as the price is determined by your insurance company, not the provider.
When checking cost through your insurance, make sure you are determining your price off the allowed amount, not the submitted amount. The insurance companies will only pay a portion of the charge submitted by a provider, so they allow a payment of $800.00 for a cpap, the amount submitted may need to be $1500.00 or more depending on the insurance. Your copay will be based on the allowed amount except in extremely rare circumstances where an insurance company has very poor DME coverage (Aetna is the most common where this is seen).
If paying cash, the price may vary wildly. Find a company that does not bill insurance to find the best price. Federal Law does not allow a company that bills Medicare to offer a lower price for a cash customer, so you will not find a lower price going through most DME providers.
To get your insurance to cover the cost of the equipment and supplies, have your doctor or sleep lab send a copy of your sleep study and the prescription to the provider you have chosen. Most Sleep Labs and doctors will do this for you automatically as this is the standard practice for these procedures.
Typically, when you go in for a sleep study they will ask you beforehand if you need a CPAP if you have a preference for a provider. If you do not, they will generally have several they work with that are in-network with all the common insurance companies. If you need a CPAP then in the morning they will send a copy of the sleep study to your doctor and to the DME provider. The DME will then obtain authorization from your insurance. The doctor will review the sleep study and sign a prescription and provide this to the DME company who will then contact you to setup either delivery of the equipment to your home or a meeting in thier facility to set you up.
4 posts
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