What’s the difference between device purchase and rental?
Whether you are getting ready to use your first CPAP machine or you’re a seasoned user about to get the latest CPAP model (have you checked out the new machines with wireless modems??) it’s important to understand these options.
Who determines if I pay for my CPAP as a purchase or rental?
If you are using health insurance to pay for your CPAP, your insurance company will determine whether they pay as a purchase or rental. Most insurance companies are paying on a rental basis, typically for about 10 months. Many insurance companies follow Medicare guidelines for CPAP equipment.
The rental rates are usually base on the purchase price. For example, if the purchase price for the CPAP machine is $800, the monthly rental fee is $80/month for 10 months. The supplies, like your mask, tubing, cushions and even the heated humidifier, are typically purchased and the rental terms only apply to the CPAP machine (aka flow generator). Read more about how much a CPAP machine and supplies cost.
Watch out for compliance requirements
After the rental period is over, you own the device. However, these insurance companies are often requiring proof that you are using the equipment and meeting their usage requirements (at least 4 hours per night for 70% of nights) in order to continue payment. If you don’t meet the compliance requirements, they will not pay. You will either have to pay cash for your equipment or return it to your equipment provider. Read more about what to do if your insurance company won’t pay because you’re not compliant.
Your insurance may require another face-to-face visit with your doctor
Another Medicare guideline that other insurance companies are starting to follow is requiring another face-to-face visit with your physician in the first months of therapy. Medicare and United Healthcare both require that patients have a clinical re-evaluation between the 31st and 91st day after starting therapy, to include:
- Treating physician documents that the patient is benefiting from therapy; and
- Objective evidence of usage (compliance data) is reviewed by the treating physician
Do I have to use my insurance to pay for my CPAP and supplies?
Of course, you don’t have to use your insurance to pay for your CPAP machine or supplies. In fact, if you don’t want to go through the hassle of proving compliance and dealing with a 10 month (or longer) rental period, you may prefer to pay out of pocket for your equipment.
For some patients who have high insurance deductibles, they end up paying out-of-pocket even WITH insurance.
If you pay cash, you can still elect to rent your CPAP machine (you’ll always purchase the supplies like mask and tubing), but it usually makes more financial sense to pay out right for the purchase. You may even end up paying less than if you used your insurance and went out-of-network. Read about the top reasons why people decide to pay cash for CPAP and supplies.
If this is your second CPAP machine (for travel or a second home) you will need to pay cash. Insurance usually won’t cover more than one CPAP machine every five years.
If you’re interested in learning more about getting a new CPAP machine, check out our online store or call us to speak to a customer service representative (877) 775-3377 option 607. We offer face-to-face set-ups or we can ship to you.
Այլ գրառումներ, որոնք ձեզ կարող են հետաքրքիր լինել.
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