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Documentation Required for CPAP Reimbursement

It is important to take important steps to ensure reimbursement from your insurance provider prior to undergoing a sleep study and receiving a CPAP (continuous positive airway pressure) mask and machine.

  1. Verify Coverage

    • The first step is to call your insurance provider to make sure that you don't need preauthorization or a referral from your primary care physician. Make sure that the lab you are going to is an in-network facility, and verify this with a representative. Ask if you need any particular documentation prior to your study. Some examples include providing a copy of your insurance card to the sleep lab and making sure a referral using your insurance provider's paperwork has been faxed to the lab and all lab work and EKG results have been sent.

    After the Study

    • After your sleep study has diagnosed you with apnea and you have had a CPAP trial, you will be given the name of a homecare suppy company. The homecare supply company may or may not accept your insurance. It is important that you verify with your insurance company which durable medical equipment companies they work with. Once you have selected a covered company, you or the sleep lab will need to send documentation in the form of a sleep study report, which are the scored results of your sleep study. This is what verifies the medical need for a CPAP device.

    Reimbursement

    • The homecare company will need a copy of your sleep study and a report written by the sleep physician stating that the CPAP device is medically necessary. This process is generally done by the sleep lab; however, ensure that the homecare supply company has received the paperwork.

    Homecare to Insurer

    • In most cases, your health insurance company will reimburse the homecare supply company directly for the CPAP device, although this can vary depending on your insurance and the homecare company policy.

    Your Rights

    • The paperwork and documentation process described beforehand will vary, and it is important for you to call your insurance company directly to verify the procedures. You can request the sleep study report from your doctor, and you have a right to the information. Keep this on hand for your records.

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