Frequently Asked Questions - Billing
1. Do I have to rent my CPAP/bi-level therapy or can I just purchase it?
Equipment coverage is covered determined by your insurance company. Our office obtains your coverage information prior to your setup and provides you with an estimate based on their information.
If your insurance company allows you the option to purchase your equipment there will be a onetime payment for the device. A majority of insurance companies require patients to rent their CPAP/bi-level device for a set period of time. This rental time period is generally 10 months but does vary between insurance companies and group policies. Upon completion of the rental period the CPAP/bi-level device converts from rental to purchase. This is similar to a rent-to-own situation where a device is rented for a period of time. Upon successful completion of the rental period you own the device and neither Everything CPAP nor your insurance company will bill for additional rental charges.
During the rental period many insurance companies require compliance. Compliance means using your device at least 4 hours a night for 70% of the time in a 30 day period. Everything CPAP submits this usage data to your insurance company to obtain the required renewed authorization for billing submission. Essentially insurance companies want to make sure their patients are using and benefiting from the devices supplied to their patients by their equipment provider.
2. My insurance company’s policy is to rent the CPAP/bi-level device for 2 months before it converts to purchase. What does that mean for me?
In this case the CPAP will rent for 2 months instead of renting for 10 months. On the third month the balance is converted from rental to purchase. So those 8 months will be billed out as one final payment for the purchase of the device instead of having another 8 months of rentals.
For example: your insurance has a "2 month convert to purchase” policy. They charge one apple per month and you were setup on therapy in January. You will pay one apple for the January rental and one apple for the February rental. In March you will pay eight apples to purchase the device. The amount of apples due is subject to being compliant with the therapy and other factors such as whether your deductible is met or your portion of co-insurance.
3. Do I need to have a follow up appointment with my physician? When and why?
Many insurance companies now require that you are compliant with your therapy and that you also have a “face-to-face” follow up appointment with your physician/provider between 31-90 days after you begin CPAP/bi-level therapy. If we are advised by your insurance company that this is a requirement we will notify you. You may still have this requirement even if Everything CPAP is not notified by your insurance company. It is always a good idea for you to contact your insurance directly for any policy specific questions.
4. I just received a bill. Has Everything CPAP submitted the charges to my insurance company?
You will receive a bill after Everything CPAP has received an EOB (explanation of benefits) and/or payment from your insurance company. An EOB is an explanation of how your insurance covered or did not cover the charges that were submitted for equipment or supplies you received. You should also receive an explanation of benefits from your insurance company in the mail or posted electronically to their patient portal. If you have questions about how your insurance company processed a claim you should contact your insurance company directly so that they can explain your coverage per your specific insurance policy.
5. Can I make a payment online?
Yes, Everything CPAP is set up to take payments online, by phone, by mail, or directly in our office.
6. What if I decide to return my CPAP/BIPAP? Will I be refunded?
Everything CPAP will stop billing for any active rentals upon receipt of a returned device. We do not prorate between billing periods. There is no refund available for any prior months that the device was on rent or when the equipment was in your possession.
Purchased devices are your property. You and/or your insurance provider purchased the device for your benefit and are therefore non-refundable. We have contact information for several local facilities who accept donations of sleep apnea therapy devices for those in need.
Supplies which have been used (i.e., mask, tubing, and filters) are purchased items. They cannot be re-used and are not refundable. Any supply item that is in new, unopened, and in resalable condition is eligible for a full refund within 30 days of the date of service.
7. Are my monthly resupplies covered by my insurance?
Insurance companies allow certain resupply items at specific intervals. Our resupply program is designed to notify you when your insurance provider has determined you are eligible to receive new supply items. Being eligible for supply items does not guarantee payment by your insurance provider.
Resupply items are subject to your policy coverage and may or may not be covered depending on your specific plan coverage (i.e., if your deductible has not been met, your specific co-insurance). Typically you will be responsible for 100% of the supply cost until your deductible has been met. After your deductible has been met supplies will be subject to your co-insurance (generally a percentage of the total supply item cost). It is important to know your specific plan coverage so that you are aware of how reordering your needed supplies will be covered by your insurance.