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.
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:
You will have a diagnostic sleep study to determine if you have sleep apnea.
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.
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.
If we are able to provide your CPAP machine and supplies, a Patient Care Coordinator (PCC) will contact you to schedule your date for set-up.
A PCC has the technical knowledge to answer your questions about CPAP usage and equipment.
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
Heart disease, including congestive heart failure, irregular heartbeat, and coronary
artery disease, as sleep apnea reduces blood oxygen levels.
Stroke, which causes a sudden loss in brain function due to ruptures or blockages in your blood vessels.
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.
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 videos for the Dreamstation and Airsense S10 full therapy machines that will walk you through these adjustments, as well as solutions for some common issues users may experience on PAP therapy.
What can I do if I have a dry nose or mouth?
If you have a heated humidifier, increase the heat level. If you do not have a heated humidifier, see about adding one to your CPAP machine. Check for mask leaks. Increased air flow may be the cause of the dryness. Or you can try using a saline nasal spray or gel.
What can I do if my mask is uncomfortable?
Check to make your mask is not too tight, readjust your headgear. Give yourself 1-2 weeks to adjust to your new mask. If you are experiencing irritation at the bridge of your nose, Hydrocortisone 1% cream may help. This product is available over the counter without a prescription. If the mask discomfort persists, please contact the Patient Care Assistants at 708.364.9606 ext. 7765 to inquire about our loaner mask program.
Why am I sneezing and/or have a runny nose?
This can occur when you are new to CPAP and usually subsides with continued use.
What can I do when I have nasal congestion?
Adding or increasing humidification may help. Also, using saline drops without any scents or medications as well as a nasal steroid inhaler.
What can I do if I feel chest discomfort?
This may be due to increased air in your lungs, which can stretch out the muscles between your ribs. You should continue to use your CPAP, as this typically subsides in about a week. Consult your doctor if the discomfort continues or becomes worse.
What can I do if I feel bloated or gassy?
This may be caused by swallowing too much air. You should consult your doctor if the discomfort continues or becomes worse. The doctor may need to adjust your pressure as it may be too high.
What if I get irritation on the bridge of my nose?
Use Hydrocortisone 1% cream and a buffer (such as a band aid or cotton round). Notify your doctor if problems persist.
What if I get irritation inside of my nose?
Use a saline nose spray or Ayrgel. These can be found at any local pharmacy and do not need a prescription. Notify your doctor if problems persist.
Why do I sometimes feel light headed or dizzy?
CPAP use may reduce blood pressure. If you feel dizzy upon awakening, rise slowly. Notify your doctor if problems persist.
Why is my water gone or almost gone every morning?
This can be caused by placing your CPAP machine too close to a window or air vent, or if your mask is not fitting properly and air is leaking. Check the position of your machine. Replace your mask cushion or pillows. If the issues persist, contact a Patient Care Assistant at 708.364.9606 ext.7765.
Why is water coming through my mask and tubing or making a gurgling sound?
Turn down your humidity setting and/or increase you tubing temperature. These procedures can be found in your user’s manual. If you need assistance, contact a Patient Care Assistant at 708.364.9606 ext. 7765.
What if my new mask will not fit into my tubing?
Every mask has a “quick disconnect” piece that is inserted into the tubing. This piece is designed to stay in the tubing once you connect your mask for the first time. Check the inside of the tubing for a plastic piece. The easiest way to remove this piece is to reconnect your mask to your tubing, place one hand on the mask and one hand on the tubing so your index fingers and thumbs touch. Then in a quick motion, snap your wrists together. You may need to try this more than once. This will provide you leverage to remove the quick disconnect piece from inside the tubing, it should be back on your mask. If you need assistance, contact a Patient Care Assistant at 708.364.9606 ext. 7765 or check out the video below!
Frequently Asked Questions Regarding PAP Maintenance
What can I use to clean my mask?
Anything you can use on a newborn, such as baby shampoo or Ivory liquid soap. NEVER use cleansers with a degreaser in them (ex. Dawn) as this will cause the silicone to deteriorate faster and may cause skin irritation. You can also use a non-scented hypo-allergenic baby wipe to wipe off the mask cushion or pillows daily. This should be done when you first wake up so it can air dry throughout the day. Also, make sure to wash and dry your face before and after each use. This will keep your skin clear and reduce the oils that can break down the silicone on the cushion or pillows.
What can I use to clean my tubing?
Anything you can use on a newborn, such as baby shampoo or Ivory liquid soap. NEVER use cleansers with a degreaser in them (ex. Dawn). If you use regular tubing (both end are the same), you can submerge the tubing in water for at least 5 minutes, then rinse it thoroughly with clean water.
If you are using heated tubing (ends are different), the end that connects to your machine can be submerged in water briefly. Then rinse with clean water.
You can hang your tubing to dry, but this is not the “best” way. You can place a common hair dryer on the COOL setting and blow cool air through the tubing for at least 2 minutes. This will more thoroughly dry the tubing and it will be ready to put back on your machine.
What can I use to clean my water chamber?
Anything you can use on a newborn, such as baby shampoo or Ivory liquid soap. NEVER use cleansers with a degreaser in them (ex. Dawn). If you are noticing a build up of sediment that is particularly stubborn, you can mix 1 part distilled white vinegar with 3 parts warm water, and let the chamber sit for 20 minutes. Make sure you thoroughly rinse it after to dispense any lingering vinegar scent.
What can I use to clean my reusable filters?
A few machines and a couple of masks contain non-disposable or reusable filters. They are typically gray or black in color. Any you can use baby shampoo or Ivory liquid soap. NEVER use cleansers with a degreaser on them (ex. Dawn). Dip the filter in soapy water and rinse with clean water, squeeze out sponge filter and rinse again. The mask filters can be air dried to use the COOL setting on a common hair dryer to dry them faster. Do NOT place a filter back into your machine until it is dry, otherwise, moisture can get into your CPAP machine and cause a shock or short. (water and electricity do not mix). Using excessively dirty filters without changing or cleaning them regularly may cause the machine to overheat, run at the wrong pressure or break.
What can I use to clean my disposable filters?
These filters, whether on a machine or a mask, cannot be cleaned. They should be replaced when dirty or at least every 4 to 6 weeks. Using excessively dirty filters without changing or cleaning them regularly may cause the machine to overheat, run at the wrong pressure or break.
Your machine itself requires maintenance to keep it running smoothly. Here are a few suggestions on how to keep up with machine maintenance:
The outside of your equipment can be dusted off with a damp cloth, but make sure not to submerge the equipment in water.
It will not harm the machine if it is left on during trips to the washroom, but do not leave the machine on (blowing) during regular periods of non-use, such as during the day.
Change (or clean) the filters on your machine regularly according to the manufacturer’s recommendations, which are in your owner’s manual. Disposable filters (white) should be thrown out and replaced with new filters.
Non-Disposable, reusable, (black) filters should be washed out thoroughly with warm, soapy water, rinsed and completely dried before placing the filter back into the machine.
Mild antibacterial dish soap or Ivory liquid is recommended.
Using excessively dirty filters without changing or cleaning them regularly may cause the machine to overheat, run at the wrong pressure or break.
The filters should be changed or cleaned more frequently under the following circumstances:
In the summer months when the windows are open.
When the machine is placed low to the ground.
When pets are in the home.
If you are prone to sinus problems.
Never block the air inlet vent where the filter is located, this is where the machine takes in air.