Why can’t I just buy my CPAP?
Insurance companies require you to rent your CPAP machine usually for between 7-13 months before you own it. This may come as a shock to many new CPAP users.
If you have finished SleepQuest’s Qualification process and have just learned about your insurance’s rental policy, you may have several questions. To clarify we’ll examine what the purpose of a rental period is and what it means for overall cost.
Why is CPAP Rental the Standard for Insurance?
Sleep apnea effects on average one out of every five adults in the US and more awareness combined with more effective testing means more people are getting treated. While CPAP therapy is the gold standard for treating Sleep Apnea it can be difficult for some patients to adjust to using it and getting the maximum benefits. Compliance with therapy is a huge part of seeing results and improving overall health. However, many patients stop using their CPAP device within the first 3 months. Insurance companies want to make sure that the patients are using and benefiting from therapy before paying for the machine.
Your CPAP device records your sleep data and transmits it either wirelessly or via an SD card. During the rental period most insurances follow the Medicare guidelines which require a minimum of 4 hours per night for at least 70% of nights.
Once the length of your rental period ends you convert to owning your machine. However, if during that period you do not meet the compliance conditions (min. 4 hours a night 70% of nights) your insurer may not cover the costs.
That is why it is important to reach out to a SleepQuest Sleep Care Specialist during this crucial adjustment period if you are having any issues using your machine regularly. Not only to make sure your insurance covers the costs, but also, so you stay on therapy and receive the full, life changing, benefits. A SleepQuest Sleep Care Specialist can help you fit your mask, work with your doctor to adjust your pressure setings, and assist with finding the correct humidity levels.
Do I also have to Rent My CPAP Supplies?
Your insurance uses a rental program for the PAP machines. Other supplies like CPAP masks, tubing filters and humidifiers, like any other covered purchase, will be paid for upfront. Your deductible and coinsurance rates will determine your out-of-pocket costs.
What is the Cost of CPAP Rental?
Usually, your monthly cost is the total price of a new CPAP machine split evenly for the length of the rental period. For example, if you have a $600 machine split over a 12-month rental period the cost per month would be $50.00.
Your deductible and coinsurance rates would still apply during this period. SleepQuest’s Patient Relations department can give you precise costs according to your insurance.
What happens if you are not compliant?
While it is called a “rental” by insurance companies, in reality, you are paying in monthly installments for your PAP. If you do not consistently meet the compliance requirements, your insurance will not continue to cover the “rental” costs and you will owe the remaining amount. So it is crucial that you stay compliant with your PAP therapy to remain healthy and not get a bill for the remaining costs owed on your PAP, which can be in the hundreds of dollars.
What are My Options if I do not Want to Rent My CPAP?
Your insurance determines your rental policy, so if you wish to own your machine outright from the beginning you must pay for it out-of-pocket.
Pros to paying out-of-pocket:
- No need to stress about meeting the compliance requirements. CPAP therapy is different for everyone and there may be a learning curve when you first start therapy. Not worrying about meeting the requirements set forth by insurance might make it easier in the long run.
- If you can’t use your CPAP, for instance sickness or travel, you will not be penalized.
Cons to paying out-of-pocket:
- While most commercial insurances will cover the cost of supply refills even if you did not get your CPAP machine through insurance Medicare requires you to rent your CPAP in order to get coverage for supply refills. In addition, Medicare will only pay for your supplies if you meet ALL the Medicare documentation requirements for the PAP device.
- While for some it may be easier to not have the added pressure of compliance when starting therapy, the rental requirements can act as an incentive for certain patients to use their CPAP consistently in the beginning. Research shows that people who use their CPAP regularly from the start are more likely to stick with it long term.
How Do I Check if I Have to Rent My CPAP?
SleepQuest’s Patient Relations and Billing departments can help you figure out the rules and requirements for your specific insurance company and policy. We are the go between your insurance company and your doctor. Once you are set up with therapy, we will also help you start a refill schedule for your supplies.
