INSURANCE & BILLING

At CPAPWarehouse.com we understand that anyone seeking treatment for sleep apnea is concerned about costs. As most of our employees have or are related to those being treated for sleep apnea, we are closely in tune with the variables that can get in the way of procuring ongoing treatment. It is our goal to be both an affordable option for apnea related products as well as provide educational tools to ensure our customers are confident and informed participants in their own health care.

Note: CPAP Warehouse can only provide general information for our customers. We cannot determine the policies and procedures for each insurance company and thus cannot guarantee that this information is accurate for your specific policy. Please verify the following information with your insurance provider before filing a claim.

DOES HEALTH INSURANCE COVER PAP THERAPY

Almost all health insurance plans now recognize and cover the therapy and consultations related to obstructive sleep apnea, but the conditions of coverage or the benefits related to coverage vary from company to individual plan. There are two main components to PAP therapy: durable medical equipment and clinical care. Clinical care refers to the range of care from in-lab sleep studies to doctor’s visits and consultations pre- and post-diagnosis. The DME side refers to the machine purchase or rental as well as replacement parts for the machine, mask, and miscellaneous items. These costs are all subject to copays, coinsurances, deductibles, and referrals depending on your plan, and sleep centers and DME providers will need to meet your insurance plan’s in-network or out-of-network provider rates in order to be covered.

Machine rental versus purchase can also be a point of contention for some PAP users. Often, if a machine is approved for rental by your insurance plan, the length of time in which you are renting coincides with the rollover of your yearly deductible. This means that even as the monthly fee is an installment payment towards the purchase of the machine, you can incur the remaining purchase price of your machine if you are set up at an inconvenient time regarding your insurance plan’s annual structuring. This adds direct cost to the patient in an unpredictable manner.

Because of this, PAP therapy can quickly become both overwhelming and expensive for the PAP user. Insurance costs for PAP equipment can run as high as $3500 for machines, and with the added need for replacement supplies, each successive need adds to the overall yearly out of pocket costs. CPAP Warehouse is a retail store, and therefore our prices are not regulated by insurance guidelines. We can offer these same products for 50-70% off on various products and devices.

AFFORDING PAP THERAPY WITH HSA, FSA, HIGH DEDUCTIBLES, OR NO INSURANCE

Use of a Health Savings Account (HSA) or Flex Savings Account (FSA) can be an effective strategy for reducing health costs, particularly continual costs like PAP therapy. Patients utilizing an HSA/FSA will be happy to know that most PAP equipment is eligible for HSA/FSA coverage, with CPAP Warehouse able to use these funds for purchases from both our store front and on our website, as these cards are typically treated as debit card transactions. These funds are usually on a use or lose basis, so why not use them to cover the costs of your PAP therapy?

Further, our mission as a company is to provide our customers with the best PAP products available at the most cost-effective prices. High-deductible plans ensure that you’re paying for your PAP therapy out of pocket, and even if you are receiving your supplies through an in-network DME provider, the provider will offer these supplies at insurance rates. Our products are offered at rates that are often significantly discounted from standard MSRP, so much so that they can be a viable option for uninsured patients or as an alternative for those patients with high-deductible plans.

BILLING YOUR HEALTH INSURANCE COMPANY FOR OUT-OF-POCKET PAP PURCHASES

It is important to understand that CPAP Warehouse is a purely retail environment. We cannot charge or bill insurance for any purchase on your behalf. We offer our supplies direct to the patient, without the variables and roadblocks that insurance can stipulate. Many customers wish to submit a health insurance reimbursement claim for supplies bought through CPAP Warehouse. To ensure patients use their insurance to the fullest extent, we have included this general set of instructions for filing an insurance claim.

GENERAL INSTRUCTIONS

• Contact the member services department of your insurance company directly to ensure that they allow subscribers to submit claims for medical expenses purchased out-of-pocket (such as the CPAP supplies you purchased through CPAP Warehouse).
• Ask your representative which form is necessary to submit the claim information. Some companies will allow you to use a policy-specific claim form. It is best to check with your provider to see what their procedure is for reimbursement of medical expenses.
• Complete the form required, including the billing and qualifying information used by insurance companies to process claims (see below: HCPCS codes, Diagnosis Codes, and Tax ID numbers).
• Attach a copy of your invoice from CPAP Warehouse. Supplies ordered on your invoice will need to be split into the appropriate HCPCS billing codes based on your purchases.
  Example: Our CPAP masks usually come with headgear. Insurance companies process the cost of the headgear and the mask separately. When you send your invoice you will need to make these separations. As a general rule, the cost of your mask alone is 70% of the total price you paid, while the headgear is 30% of the total price. Using this information will allow you to split these costs into the correct codes for your insurance company.
• Submit the claim form and invoice to your insurance company in the method they prescribe (most require you mail; some will allow you to fax).
• Wait for reimbursement. Usually, insurance companies say they can complete claims within 30 business days. Check with your company for their specific turnaround time.

HCPCS (Healthcare Common Procedure Coding System) BILLING CODES

The following HCPCS codes are used by insurance companies to process claims. Codes should correspond to each separate item on your invoice.

Note: Items such as CPAP bed pillows, batteries and DC adapters are not covered as they are considered luxury products.

PHYSICIAN DIAGNOSIS CODE

Insurance companies require you to provide a code associated with your specific medical diagnosis. The ICD-10 diagnosis code for Obstructive Sleep Apnea is G47.33. To ensure that you have the correct code for your diagnosis, contact your physician.

OUR COMPANY INFORMATION

Your insurance company might require information regarding CPAP Warehouse to process your claim so please feel free to reach out to us at info@cpapwarehouse.com for any information that may be required.