Is it Time to Replace your CPAP or BiLevel Equipment?If you are one of the many patients being seen routinely in our clinics you may already be aware of the improvements that have been made in both masks and CPAP and BiLevel machines. New technology and design improvements have made machines more comfortable, easier to maintain and easier to travel with. Many users are not replacing their CPAP or BiLevel masks and supplies as often as recommended, and are unaware of their durable medical equipment (DME) health insurance benefits. Most insurances will allow you to replace your CPAP or BiLevel unit after a period of time, and some insurances allow you a certain amount of money you can spend each year on equipment. Below is list of reimbursement information for major insurance companies. Arizona Insurance Guidelines - COMING SOON! If you would like to find out if you are eligible to replace your equipment, or for information on insurance companies that are not listed below, please contact one of our insurance verification specialists at 877-535-7243 or email us at supplies@sleephealth.com. You always have the option of purchasing a new CPAP or BiLevel unit yourself. For pricing information and to learn more about the units please e-mail Don Ordway, CRT, Manager of Ancillary Services at don_ordway@sleephealth.com. We look forward to helping you obtain the right equipment so that you can sleep well and maintain the quality of your health and life! MASSACHUSETTS INSURANCE GUIDELINES Aetna Blue Cross Blue Shield - If you have a DME account, you may obtain new equipment yearly.
- If you have $1500 per year, your CPAP unit would be covered in full.
- If you have $750 per year, you would have an out of pocket expense for the remaining balance.
BMC HealthNet Plan - Based on medical necessity. No specific guideline.
Commonwealth Care Alliance - Allows a new CPAP or BiLevel unit every 5 years.
- CCA allows a new mask with headgear every 6 months.
- CCA allows a new hose every month.
Commonwealth Indemnity Plan PLUS - CPAP/BiPAP must be broken beyond repair, and patient must see a Respiratory Therapist to document this prior to possible replacement.
- Allows a new mask and headgear at least every 6 months or as medically needed.
Harvard Pilgrim Health Care- Allows a new CPAP or BiLevel unit every 5 years.
- Allows new mask every 3 months.
- Allows new headgear every 6 months.
Medicare - Allows a new CPAP or BiLevel unit every 5 years and covers 80% of the allowable.
- Medicare allows a new mask with headgear every 6 months.
- Medicare allows a new hose every 3 months.
Neighborhood Health Plan (NHP)- Allows a new CPAP or BiLevel unit every 5 years, or as medically needed.
- Allows a new mask and headgear every 6 months with prior approval from NHP
Oxford Health Plan- Each plan is different, supplies are based on medical necessity and CPAP is GENERALLY every 3 calendar years, depending on plan.
TRICARE- Machine must be broken beyond repair and supplies are medically necessary.
Tufts Health Plan- Sleep HealthCenters is a Participating Provider with Tufts Health Plan. For more information about what services may be covered under your plan, call our reimbursement and billing department toll free at (877) 535-7243.
UnitedHealthcare (UHC)- Each plan is different, supplies are based on medical necessity and CPAP is GENERALLY every 3 calendar years, depending on plan.
RHODE ISLAND INSURANCE GUIDELINES Aetna- Based on individual patient policy and based on Medical Necessity
Blue Cross Blue Shield of Rhode Island- CPAP/BiPAP must be broken beyond repair, and patient must see a Respiratory Therapist to document this prior to possible replacement.
- Mask and Headgear: 2 times per year.
- Nasal Pillows, Filters and Tubing 12 times per year (once monthly)
CIGNA - Based on individual patient policy and based on medical necessity.
Harvard Pilgrim Health Care- Allows a new CPAP or BiLevel unit every 5 years.
- Allows new mask every 3 months.
Medicare - Allows a new CPAP or BiLevel unit every 5 years and covers 80% of the allowable.
- Medicare allows a new mask with headgear every 6 months.
- Medicare allows a new hose every 3 months.
Neighborhood Health Plan of Rhode Island - Allows a new CPAP or BiLevel unit every 5 years, or as medically needed.
- Allows a new mask and headgear every 6 months with prior approval from NHP.
TRICARE- Machine must be broken beyond repair and supplies are medically necessary.
United Healthcare (UHC)- Based on individual patient policy. Each plan is different and based on Medical Necessity.
- Generally, upgrades are allowed every 3 calendar years or based on Medical Necessity (if machine broken beyond repair), but not guaranteed.
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