My CPAP stopped working last night

My CPAP stopped working last night. With a little bumping and pushing it finally turned on and I slept all night with it.

This morning it would not start so I called the DME. The person on the phone asked if I could bring it in and since it is on my way to work I told him I could be there in about 30 minutes. He told e that would be fine.

When I got there the tech kept telling me I should have setup an appointment - to which I replied that I called and was told to come in. He took care of me anyway as it was the power supply. All in all a good experience.

But here's my question:

He told my machine was warrantied for two years so the new power supply was covered and if it required a new machine that would have been covered. He also told me my insurance will only let me get a new machine after 5 years.

So what happens if it breaks again after it is two years old? Will I have to foot the bill?

Something here doesn't add up.

Thanks.

Hi bakermo,
That sounds like the case. I'm thinking that I should consider a special "CPAP" fund, in case something breaks out of warranty.
If that happens, secondwindcpap.com is a great place to find gently used and open box machines. I thought I was going to have to get one from them, when UHC finally came through with my Autoset.

I copied the DME section from my plan documents - I have United Healthcare plan, but any plan should have a similar document showing what they cover. I highlighted the areas that would apply to this situaltion. I have good insurance, I pay dearly for it, but if it breaks they fix or replace it. Check, read, and understand your plan documents. If you have a question call the insurance company or talk to your HR department if applicable.


Durable Medical Equipment


The plan pays for Durable Medical Equipment that is:

● Ordered or provided by a Physician for outpatient use;

● Used for medical purposes;

● Not consumable or disposable;

● Not of use to a person in the absence of a sickness, injury or disability;

● Durable enough to withstand repeated use; and

· Appropriate for use in the home.

If more than one piece of DME can meet your functional needs, you will receive Benefits only for the most Cost-Effective piece of equipment. Benefits are provided for a single unit of DME (example: one insulin pump) and for repairs of that unit. If you rent or purchase a piece of Durable Medical Equipment that exceeds this guideline, you may be responsible for any cost difference between the piece you rent or purchase and the piece UnitedHealthcare has determined is the most Cost-Effective.

Examples of DME include but are not limited to:

· equipment to administer oxygen;

· equipment to assist mobility, such as a standard wheelchairs;

· Hospital beds;

· delivery pumps for tube feedings;

· burn garments;

· insulin pumps and all related necessary supplies as described under Diabetes Services;

· external cochlear devices and systems. Surgery to place a is also covered by the Plan.

· braces that stabilize an injured body part, including necessary adjustments to shoes to accommodate braces. Braces that stabilize an injured body part and braces to treat curvature of the spine are considered Durable Medical Equipment and are a Covered Health Service. Dental braces are excluded from coverage

· equipment for the treatment of chronic or acute respiratory failure or conditions.


No time restriction on replacement. Replacement is covered if necessitated by:

· a change in the patient's physical condition

· the equipment is no longer functional

Upgrades from a functional device are not covered unless one of the criteria above is met.

Repair of DME is covered as needed.

The Plan also covers tubings, nasal cannulas, connectors and masks used in connection with Durable Medical Equipment.

bakermo wrote:My CPAP...told my machine was warrantied for two years so the new power supply was covered and if it required a new machine that would have been covered. He also told me my insurance will only let me get a new machine after 5 years.

So what happens if it breaks again after it is two years old? Will I have to foot the bill?

Something here doesn't add up.

Thanks.

That all depends on how well your DME supplier and your insurance company watch your back. Your insurance company has a replacement schedule for CPAP parts and other durable medical equipment, and they are only obligated to honor that schedule. That being said, if you have a good insurance company and/or a good DME supplier, then they may repair/replace your equipment earlier than the schedule at their option. For example, I had a conversation with my DME supplier rep regarding masks when I was starting the mask-selection process. He told me that my insurance company was very flexible on replacing equipment as long as they did not suspect a pattern or fraud or abuse. I hope you also have an insurance company that is willing to work with you.

In the meantime, take your time and get yourself a back-up CPAP machine on craigslist or elsewhere if you can find one for a good price, and cross the CPAP machine repair/replacement bridge if or when you ever get to it. Best of luck.

In some cases, the dead equipment may need to be certified as unrepairable before insurance may replace it off-schedule.
If an item is medically necessary and prescribed by a doctor, sometimes that might work.
At the very least, a nice letter to the manufacturer is worth a shot.