PAP Therapy and Filing for Insurance Reimbursement

If you’ve recently made a PAP equipment purchase with us, you may be able to receive reimbursement from your insurance provider by submitting an insurance reimbursement claim.

Wondering how to submit a claim? We’ve outlined the process below and put together some helpful resources to get you started.

More money in your pocket

More money in your pocket

Easy & Convenient

Easy & Convenient

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File Previous Orders

Insurance Companies

How Do I File for Insurance Reimbursement on My PAP Purchase?

Most insurance plans offer partial coverage for PAP equipment once you meet your deductible. You can submit a claim to your insurance provider to receive reimbursement for out-of-pocket PAP equipment costs.

We’ve outlined the general process for filing for reimbursement below to help you get started. Note that the specifics may vary depending on your insurance provider.

1

Complete your medical claim form

Download your medical claim form directly from your insurance provider and fill out the form. After you’ve completed your medical claim form, you’ll need to submit the form, along with an itemized receipt, and prescription for your purchase to your insurance provider to start processing your reimbursement.

2

Attach a copy of your prescription and receipt

Share information about your brand with your customers. Describe a product, make announcements, or welcome customers to your store.

3

Submit your claim form, prescription, and receipt to your insurance provider

Share information about your brand with your customers. Describe a product, make announcements, or welcome customers to your store.

4

Receive your reimbursement

Share information about your brand with your customers. Describe a product, make announcements, or welcome customers to your store.

Insurance vs. Out-of-pocket

While insurance will typically cover some of the costs involved in purchasing PAP equipment, there are often restrictions that accompany shopping with insurance. Some insurance plans require you to show proof of use of your PAP equipment or meet other conditions to qualify for coverage.

Most insurance plans offer coverage for PAP equipment only after you meet your deductible. When making your decision, calculate whether your PAP equipment is likely to cost more than your deductible, both now and in the long run. Don’t forget to budget for the ongoing costs of tubes, filters, and other accessory replacements.

Here’s a side-by-side breakdown of the terms of purchasing PAP equipment with an insurance provider in mind compared to purchasing entirely out-of-pocket.

Machine selection

Machine condition

BIPAP Availability

Fulfillment

Cost

Co-Payments

Rental term

Prescription length

Usage requirements

Follow ups

Data Privacy

Insurance

Restricted
Possibly used
Requires APAP fail
Supplier dependent
Lower upfront, higher over time
Depends on insurer
Usually 3/10/13 months
1 year
4 hrs/night for 21 days in 30-day time
Every 6 months
Monitored, usage proof required

Out of pocket

No restrictions
New
Always available
Immediate
Higher upfront, lower over time
None
None
99 years
None
None required
No monitoring

Frequently Asked Questions

Get quick answers to common questions that people have about PAP equipment and insurance.

Do you accept health insurance?

In order to offer you the very best value, we do not deal with health insurance companies directly. This allows us to save a great deal on overhead and administrative expenses and pass along the savings to you. While many insurance companies will provide reimbursement for devices, we do not directly accept any insurance outside of health savings accounts (HSAs) and flexible spending accounts (FSAs). We are happy to provide you with an invoice for purchased medical products and services that you may submit to your insurer for reimbursement. We suggest confirming with your insurance plan regarding what benefits are included for DME (durable medical equipment).

How often does insurance cover PAP machines?

Most insurance plans offer partial coverage for PAP machines once you meet your deductible. Medicare participants are responsible for paying their deductible, plus 20% of the machine rental. If you have a high deductible under your health insurance policy, you may inadvertently end up covering the full cost of your PAP machine.

Does my deductible apply to PAP equipment?

Typically, your deductible applies to essential PAP equipment, not including optional accessories. Most providers have replacement schedules for components such as tubes, masks, and filters that indicate how often replacements are covered. If you require more frequent replacements of certain components, those costs may be out of pocket.

Will insurance pay for sleep apnea sleep studies?

Most insurance plans cover a portion of the cost of your sleep studies, including studies conducted in a sleep lab or at home. Typically, you need a referral for a sleep study in order to receive coverage. Your doctor must determine which type of study is right for you. Insurance providers almost always request that you present an obstructive sleep apnea diagnosis before starting coverage for a PAP machine and related equipment.

Does Medicare cover CPAP?

Medicare considers CPAP devices to be durable medical equipment and provides 80% coverage under Part B as long as you meet certain conditions. First, your doctor must diagnose you with obstructive sleep apnea following an approved laboratory sleep study or an at-home sleep study, and give you a prescription for a CPAP machine.

Then, Medicare covers a 12-week initial period of CPAP therapy for obstructive sleep apnea, as long as you meet the following requirements:

  • You have an hourly AHI between 5 and 14 and a comorbid condition related to obstructive sleep apnea, including hypertension, history of stroke, heart disease, excessive daytime sleepiness, insomnia, mood disorders, and impaired cognition; or
  • You have an hourly AHI of 15 or higher.

You must also meet Medicare’s compliance requirements, which state that you must use the machine at least 4 hours per night, 70% of the time or more, during the first 3 months. If you fail to meet these requirements, you have to begin the process again. This involves completing another sleep study, either in a lab or at home, and obtaining another prescription from your doctor.

If the CPAP therapy helps improve your sleep apnea symptoms during the 12-week period, Medicare continues to cover the cost of your CPAP equipment. With Original Medicare coverage, you pay 20% of the machine rental plus the cost of supplies such as the CPAP mask and tubing. Once you meet your Medicare Plan B deductible, Medicare pays for the rental of the machine for 13 months if you use it continually. Once the 13 months have passed, you own the machine.