Insurance Companies
Insurance Companies
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!
Re: Insurance Companies
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.
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.
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: DreamWear Nasal CPAP Mask with Headgear |
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Re: Insurance Companies
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.
Last edited by oklajohn on Sun Feb 27, 2022 4:56 pm, edited 1 time in total.
- Okie bipap
- Posts: 3555
- Joined: Thu Oct 15, 2015 4:14 pm
- Location: Central Oklahoma
Re: Insurance Companies
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.
_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Mask: Evora Full Face Mask - Fitpack |
Additional Comments: IPAP 20-25, ps 4, OSCAR software |
Growing old is mandatory, but growing up is optional.
Re: Insurance Companies
Thanks Okie bipap
Re: Insurance Companies
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.
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.
_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/ |
I may have to RISE but I refuse to SHINE.
If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.
If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.
Re: Insurance Companies
I have Medicare and Federal Blue Cross/Blue Shield and have never paid for anything since I've been on Cpap.
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Machine: ResMed AirCurve 10 ASV Machine with Heated Humidifier |
Mask: Evora Full Face Mask - Fitpack |
Additional Comments: AirCurve 10 ASV, Oscar V1.0.1-r-1 |
US Navy Retired 1973,AirCurve 10 ASV, Mode: ASV Auto, Min EPAP: 7.2, Max EPAP: 15.0, Min PS:4.0, Max PS: 15.0, Mask ResMed Airtouch F20, Backup: (2) AirCurve 10 ASV
Re: Insurance Companies
including that drink in your hand? (i mean tentacle)
_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
people say i'm self absorbed.
but that's enough about them.
Oscar-Win
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1-Win64.exe
Oscar-Mac
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1.dmg
but that's enough about them.
Oscar-Win
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1-Win64.exe
Oscar-Mac
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1.dmg
Re: Insurance Companies
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.
_________________
Machine: ResMed AirCurve 10 ASV Machine with Heated Humidifier |
Mask: Evora Full Face Mask - Fitpack |
Additional Comments: AirCurve 10 ASV, Oscar V1.0.1-r-1 |
US Navy Retired 1973,AirCurve 10 ASV, Mode: ASV Auto, Min EPAP: 7.2, Max EPAP: 15.0, Min PS:4.0, Max PS: 15.0, Mask ResMed Airtouch F20, Backup: (2) AirCurve 10 ASV
Re: Insurance Companies
your avatar has a drink in it's tentacle is all.
_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
people say i'm self absorbed.
but that's enough about them.
Oscar-Win
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1-Win64.exe
Oscar-Mac
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1.dmg
but that's enough about them.
Oscar-Win
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1-Win64.exe
Oscar-Mac
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1.dmg
Re: Insurance Companies
Appreciate all the info provided. Sounds like if I watch things closely, I should be ok, reimbursement-wise.
Re: Insurance Companies
OK
_________________
Machine: ResMed AirCurve 10 ASV Machine with Heated Humidifier |
Mask: Evora Full Face Mask - Fitpack |
Additional Comments: AirCurve 10 ASV, Oscar V1.0.1-r-1 |
US Navy Retired 1973,AirCurve 10 ASV, Mode: ASV Auto, Min EPAP: 7.2, Max EPAP: 15.0, Min PS:4.0, Max PS: 15.0, Mask ResMed Airtouch F20, Backup: (2) AirCurve 10 ASV
Re: Insurance Companies
@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.
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
ResMed AirSense 10 Autoset with built in humidifier
Resmed P10 pillow mask
Resmed P10 pillow mask