CPAP Private Insurance FAQs

2. Once the form is submitted, you are under NO OBLIGATION to receive equipment and supplies, and no claim will be submitted at that time. You can close your inquiry with us if you are not satisfied with the estimate provided.

3. We cannot know what your private insurance provider will cover until you verify your insurance info via our Coverage Verification form or call us at 1-866-994-BMHI(2644), as insurance policies vary greatly. Please note that your co-pay for durable medical equipment and your co-pay for a general doctor’s office visit are not the same. Some plans do not cover treatment of sleep apnea at all. Some plans cover CPAP supplies, and others do not. Some plans cover 100% of the cost with no deductible, while some plans cover only 50% with a very large deductible, and everything in-between. By providing your insurance info to us, we will be able to give you an estimated co-pay and detail what exactly is covered by your plan.

4. “In network” means that a service provider (in this case, us) has a contract in place with a certain insurance company and can submit claims to it. The contract details pricing of services between the provider and the insurance company. “In network” entails that the cost of services provided by the service provider may be reimbursed at “in network” rates (more covered).

5. If you wish to find out on your own if you’re covered, simply contact your insurance company using the phone number on your insurance card. When you place the call, be sure to have your policy and group ID’s ready. The diagnosis code for obstructive sleep apnea is 327.23. Below are a few questions you should be prepared to ask:

Insurance Billing Codes for equipment associated with the treatment of sleep apnea:

If you are considering self-filing a claim, ask the insurance rep with whom you speak what information needs to be submitted with a claim (the most commonly requested pieces of info are the complete sleep study, a prescription and a letter of medical necessity)

6. No, the plan name is not enough to find out your co-pay. You generally need to know your policy ID and group ID to find out information about your coverage. Even within the same company, benefits and coverage may vary widely, so having this detailed information is crucial for insurance verification.

7. If you have private insurance, whether you owe anything at the time of shipment is dependent upon your plan. We will provide you with an estimate of this co-pay after you complete our verification form. For plans with 100% coverage of sleep apnea and no annual deductible, there will be no co-pay and you will only be responsible for the shipping charges. For plans without 100% coverage or plans in which the annual deductible is not yet met, there will be a co-pay and shipping charges at the time of shipment.

Medicare holders will have no payment at the time of shipment. Shipping costs will not be billed to you nor Medicare. If you do not have secondary insurance, you will be billed for the 20% not covered by Medicare AFTER Medicare makes payment. If you have secondary insurance, a claim will be submitted to that provider for the remainder after payment is made by Medicare.

8. Private insurance companies and Medicare do not cover DC power, software, and the like (batteries, cables, smart card readers, etc). However, you will find a wide variety of these accessories available for self-purchase at low prices at CPAPSupplyUSA.com.

9. Whether you need a full set-up or just replacement supplies, BMHI has the most extensive selection of sleep therapy needs in the industry. Please refer to our supply chart on frequency of replacement supplies

10. The Federal Government sets a fee schedule for Medicare and insurance companies. Equipment dealers must bill insurance companies and Medicare at these set prices or higher. The Federal Government fee schedule acts as a minimum price for dealers to charge for durable medical equipment.

11. Most insurance companies allow a new CPAP machine every 5 years. Please call our office for verification.

12. We handle all warranty issues for you as any medical equipment company should. We will take care of sending your machine to the manufacturer for repair and as long as the problem did not arise from patient abuse, there will be no out of pocket expense for you.