Insurance/Cpap Question

I have been on CPAP for over 7-8 years. When I first went on my insurance carrier at that time bought my first machine and supplies for a while. After my employer changed insurance I was no longer covered for anything CPAP related until I met my deductible. They change insurance companies every 2-3 years anyway but now they are self insured. Along the way I bought a RESMED 10 for her off here and m over my settings over and buy seals for my mask which is a RESMED Mirage Quattro off line and pay for them out of pocket.

I just had eyelid surgery and have now met my deductible for the year. So I want to get a new machine and as many supplies this year as possible. Since the Mirage Quattro is a big mask that goes on the forehead, I sourced a RESMED F20I to keep pressure off my nose and forehead. I have not had trouble with either mask and my AHI runs 1.5-3.2 usually.

So here is my question, where is the cheapest place for me to go online (I assume) that will do the online prescription and write me for a new machine so my insurance will buy it and some supplies that I can accumulate through the end of the year when I will no longer meet my deductible again? And should I get a new 10 or upgrade to the 11? I have had an 8 then now a 10 and really didn't notice much difference in sleep. I used the same settings and got some advice here on tuning that as well. I run pretty high pressure.

My regular doctor will give me a script but I dont have another appointment for several months. HE is not a CPAP expert but an internist that just reviews my chart. He is not the pulmonologist that originally put me on CPAP and did my sleep study. I haven't had a new sleep study in 7-8 years.

Advice?

Thanks
Don

rotts4u wrote: ↑

Fri Feb 03, 2023 6:02 pm

Advice?

Thanks
Don

leave a private message for forum member lsat.

he often has gently used machines to sell. he primarily sells resmed machines.

good luck!

Check your insurance coverage to see what they will actually pay for. They may or may not reimburse you for purchases made over the internet. Many insurance companies require you to purchase your equipment through specific DME suppliers.

Agree with Okie Bipap. The place you must start is with your insurance company. You need to know what their policy says about reimbursement for CPAP and supplies. Do you need to use a preferred provider? Can you use any DME? What documentation do you need in order to have it covered (i.e. do they require a sleep study done within a certain number of years)? Will they reimburse you or only pay the DME directly? What is your co-pay (if any)?

To get it in writing, ask your insurer to provide you with an "Evidence of Coverage" (EOC) which is the actual contract with your insurer you've never seen unless you knew to ask for it. Read the section on "Durable Medical Equipment and Supplies" carefully.