How to Get the Newest CPAP From My Insurance

CPAP (Continuous Positive Airway Pressure) devices have gotten sleeker and quieter over the years, and you may now want a new one to replace your old unit which could be keeping you awake or is no longer working if it's out of warranty. If you have new insurance, have recently gone on Medicare or have experienced a change in your sleep apnea condition, you can get a new CPAP paid for by your insurance.

Instructions

• 1

  Contact your pulmonologist or sleep medicine physician for a new prescription for a CPAP machine, unless you've had a sleep study or prescription less than one year ago. You will need a new prescription with the pressure information for the machine to fulfill the insurance company's requirement of medical necessity.

• 2

  Contact your PPO (Preferred Provider Organization) and determine what the deductible, yearly maximum and any co-insurance will be for new equipment if your existing machine is over three years old. The deductible is the amount you will have to pay before the insurance begins to cover any expenses, the yearly max is how much the insurance will pay for a covered benefit, and the co-insurance is the percentage you will pay of the monthly rental or purchase of the machine. If you have a new insurance carrier, you can get a new machine regardless of when you received the previous one. Now that you are aware of the costs that you will have to pay and those covered by the insurance company, you can call the durable medical provider of choice to pick up a new machine.

• 3

  Contact your primary care provider if you have HMO (Health Maintenance Organization) insurance and if your machine is over three years old. Ask for an authorization request for a new machine. Tell your primary care physician where you had your sleep study done. He will need to fax that information to the authorizations department along with a new prescription using the pressure settings on your current machine. Once the referral goes through, you will be contacted by the durable medical equipment provider to pick up your CPAP machine. You are also eligible for a new machine if you are a new HMO member, regardless of when you received your last machine.

• 4

  Contact the medical equipment provider if you are a new Medicare recipient or you are currently on Medicare and your machine is over five years old. The provider can request the paperwork from the sleep lab but you will have to provide the current prescription. The patient care coordinator who processes your order will check eligibility with Medicare to ensure that there are no same/similar issues involved in terms of medical equipment. She will schedule an appointment for you to pick up the machine or have it delivered.

• 5

  Consider a BiPAP (Bi-level Positive Airway Pressure) machine if your CPAP unit is not working optimally for you. The doctor will have to prove that the CPAP treatment is failing through an overnight oximetry or a return to the sleep lab. If there is a change in diagnosis, you can get a BiPAP regardless of when you acquired the CPAP. Medicare, though, will want the CPAP returned to the medical supplier if it is still on rental.