Whether you are getting ready to use your first CPAP device or a seasoned user about getting the latest CPAP model, it’s significant to understand these choices.
Who Determines if I Pay for My CPAP as a Purchase or Rental?
If you are utilizing health insurance to pay for your CPAP, your insurance company will determine whether they pay as a purchase or rental.
Many insurance companies are paying on a rental basis, typically for around 10 months. Most insurance companies follow Medicare guidelines for CPAP machines.
The rental rates are normally based on the purchase price. For instance, if the CPAP device’s purchase price is $800, the monthly rental fee is $80/month for 10 months. The supplies, such as your mask, tubing, cushions, and even the heated humidifier, are typically purchased, and the rental terms only apply to the CPAP device (aka flow generator).
Watch Out for Compliance Requirements When Buying or Renting CPAP Machine
After the rental period is over, you own the equipment. Though, these insurance companies are often requiring proof that you are using the device and meeting their usage requirements (at least 4 hours per night for 70% of nights) to continue payment. If you don’t meet the compliance necessities, they will not pay. You will either have to pay cash for your device or return it to your equipment provider.
Your Insurance May Need Another Face-To-Face Visit with Your Doctor
Another Medicare guideline that other insurance companies are starting to follow is needing another face-to-face visit with your physician in the first months of therapy. Medicare and United Healthcare require that patients have a clinical re-evaluation between the 31st and 91st day after beginning therapy, including:
- Treating doctor documents that the patient is benefiting from CPAP therapy; and
- The treating doctor reviews objective evidence of usage (compliance data).
Do I Have to Utilize My Insurance to Pay for My CPAP and Supplies?
Of course, you don’t have to utilize your insurance to pay for your CPAP machine or supplies. In fact, if you don’t want to go through the hassle of proving compliance and dealing with a 10 month (or longer) rental period, you may opt to pay out of pocket for your device.
For some patients who have high insurance deductibles, they finally pay out-of-pocket even WITH insurance.
If you pay cash, you can still opt to rent your CPAP machine (you’ll always purchase the supplies like mask and tubing), but it typically makes more financial sense to pay outright for the purchase. You may even end up paying less than if you used your coverage and went out-of-network.
If this is your second CPAP machine (for travel or a second home), you will require to pay cash. Insurance usually covers a maximum of one CPAP equipment every five years.
References and Resources