Frequently Asked Questions Regarding Insurance Billing of Machine and Supplies
When you say “I am eligible” for a supply, does that mean my insurance covers it at 100%?
No, when we use the word “eligible” we simply mean whatever supplies you would like to
purchase can be billed to your insurance company. How much you will have to pay depends
on your benefits with your insurance company. Your Explanation of Benefits (EOB) will show
the amount billed (same amount billed to all insurance companies). Your insurance provider
will reduce this amount down to their reasonable and customary amount and applies it to
your benefits. The insurance company will then tell Advanced Health Services how much
you will need to pay for your supplies.
If you would like to know exact pricing for each supply, please see the Supply Replacement Schedule for billing codes associated with each of your supplies. You can use these codes to contact your insurance provider and request pricing tables for the supplies you use with your machine.
What is the difference between a deductible and coinsurance?
A deductible is the amount you pay for health care services before your health insurance begins to pay. A deductible amount is usually calculated over a 12 month period (most are January 1 to December 31, but not all). This means you must meet a new deductible whenever you begin a new benefit year.
Coinsurance is your share of the costs of a health care service. It is usually figured as a percentage (%) of the total charge for the service. You start paying coinsurance after you have paid your plan’s deductible.
Do not confuse coinsurance with copayment. Copayment is a specific amount you pay at the doctor’s office before you meet your deductible. Coinsurance is a percentage of a provider’s charge that you may be required to pay after you have met your deductible.
Example:
If you received $500 of CPAP supplies, your insurance provider will reduce this amount down to their reasonable and customary amount; in this case, $350. If you have a $300 deductible with an 80% coinsurance, you will pay $300 (your deductible) with $50 remaining ($350-$300 = $50), then you will pay 80% of $50 ($50 x 80% =$40). Your insurance provider will pay $10.
If you want to know your deductible amount, your coinsurance portion (20%, 10%, etc.), or how much has been met for each year-to-date, please contact your insurance company or Human Resource Department for details.
How much will I have to pay for my CPAP machine?
There is no one answer to this question because there are so many variables to insurance and individual benefits.
Quick overview to help understand how the process works:
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You will have a diagnostic sleep study to determine if you have sleep apnea.
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If you are diagnosed with sleep apnea, you will then have a titration sleep study to determine what pressure is needed to eliminate your sleep apnea.
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Advanced Health Services billing department will check your benefits after this second study to verify that we are in-network with your insurance and can provide you with a CPAP machine and supplies.
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A Technician has the technical knowledge to answer your questions about CPAP usage and equipment.
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If you have questions about approximately how much it may cost, you can contact the Advanced Health Service Billing Department at 708.364.9606 ext 7763. NOTE: they can only provide an estimate. If you would like more detailed information, you will need to speak with your insurance provider.
Why do I need a Download?
As there are several types of CPAP machines, the following information is a general guideline. In addition, health insurance providers and even policies from the same provider can vary greatly.
That being said, many insurance companies are requiring a download of usage before a CPAP machine may be purchased. Many insurance companies will rent a CPAP machine for one to three months to make sure a patient will be able and willing to use their CPAP machines before they are purchased. The guidelines set are that the CPAP machine be used for 4 or more hours per night 70% or more in a 30 day period.
Today, most CPAP machines have an SD card and/or internal memory which log your usage.
For new CPAP users, it is recommended that we have a download after 30 days. This will help determine usage, issues and allow time to make adjustments.
Most insurance companies require a 90 day (3 month) download, which will need to meet or exceed the 4 hours per night 70% or more per month. If this is NOT done, the machine may need to be rented or returned per insurance guidelines.
Frequently Asked Questions Regarding PAP Equipment and Usage
Why do I need CPAP therapy?
Proper breathing during the night is a powerful incentive for pursuing sleep apnea treatment,
but there are many other reasons to treat this condition. Untreated sleep apnea is closely
related to:
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Heart disease, including congestive heart failure, irregular heartbeat, and coronary
artery disease, as sleep apnea reduces blood oxygen levels.
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Stroke, which causes a sudden loss in brain function due to ruptures or blockages in your blood vessels.
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High blood pressure, which is the increased force of blood pushing on the walls of the arteries as the heart pumps blood. It is a precursor for both a stroke and heart attack.
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Diabetes, which is an inability to produce or use insulin in the body, is linked to sleep apnea, glucose intolerance, and insulin resistance.
Many people with serious sleep apnea develop these conditions or these conditions recur if they stop using the mask for a time. Consistent use of the machine can prevent medical emergencies and decrease medical expenses.
Treating sleep apnea also helps keep you more alert and more able to concentrate, which reduces motor vehicle accidents and keeps you more productive on the job. Most users find themselves less apt to get depressed and have a better quality of life as a result. You will also snore less or more quietly, which will keep you from disturbing your household members.
PAP therapy can help you attain a better quality of life as you feel better rested.
YOU'VE BEEN SET UP WITH A NEW MACHINE: WHAT NOW? How do you adjust your comfort settings? Do you require a visual to aid your user manual? Below you'll find a video for the Airsense S10 full therapy machine that will walk you through these adjustments, as well as solutions for some common issues users may experience on PAP therapy.
