| Greetings! |
Thank you for subscribing to our newsletter!  We hope that the information provided here is helpful for you, and although we specialize in positive airway pressure therapy for Obstructive Sleep Apnea, we encourage you to call us whenever you have any questions about sleep, sleep disorders, and treatments. Our knowledgeable staff is here to help and point you in the right direction if we do not have the answers that you need!
|
Therapy Tips
|
 Know and Understand Your Insurance Coverage
Those of you who utilize insurance benefits to pay for your sleep health care and medical supplies undoubtedly know that insurance coverage is often less than ideal and can be very confusing for you and your medical providers. It is in your best interest to become familiar with all aspects of the coverage offered by your particular health plan so that you are not surprised by unexpected charges and so that you are able to identify when a mistake may have been made.The following are a few general guidelines regarding insurance coverage for sleep health products. Please keep in mind that your particular plan has its own rules, and contracts between health plans and equipment providers differ. We have seen cases where spouses on the same plan have obtained equipment from 2 different providers, but the coverage rules changed slightly because each provider had a different contract with that health plan. There is no way for one provider to know the contract in place for another provider, so it is up to you to know how your coverage will play out with the provider you choose. General guidelines: - Most health plans (not all) do not pay for CPAP and/or bilevel machines outright. Instead, they allow for a "rent to purchase" plan which usually spans 10-15 months.
- If your health plan requires that your machine be billed on a "rent to purchase" plan, the monthly "rental" may carry over into the new year deductible, depending on the month you start therapy.
- The cost of a CPAP and/or bilevel is the same whether it is purchased outright or put on a rent to purchase plan. However, contracted allowable prices may differ between providers.
- Masks and other supplies are always paid as a purchase outright, and coverage of these items will depend on the deductibles and co-pays of your plan.
All equipment providers can and usually will obtain benefit information from a person's health insurance company before providing services, and that information should always be explained to you prior to giving you the equipment. The amount of information providers are able to obtain about your coverage is limited. It is your responsibility as the consumer to obtain and understand this benefit information from your insurance plan yourself. It has been our experience that the information you obtain can differ from that which the provider obtains when contacting the same insurance company, which only adds to the confusion of what is and what is not covered. And anytime you contact your insurance company regarding benefits quoted, be sure to write down the name of the person you spoke to as well as a call reference number, as all calls made are recorded and/or documented.
|
