Understanding Your Bill
Below you'll find answers to some of the most common questions about CPAP through insurance and understanding your billing statement.
When you get your CPAP or CPAP supplies through insurance, you’re probably going to run into these terms. Here’s what you need to know.
- Deductible - The amount you have to pay before your insurance plan will split the cost.
- Copay - When insurance splits the bill, copay is the part you owe– as a fixed price. If the bill changes, your cost stays the same!
- Coinsurance - When insurance splits the bill, coinsurance is the part you owe– as a percentage. If the bill changes, your cost changes too.
- Out of Pocket Max - The most you have to pay before your insurance plan picks up the whole bill for covered healthcare.
Billing Statement FAQ
If my CPAP Supplies are "covered" through insurance, why am I getting a bill?
When any health benefit is covered on an insurance plan, this doesn't always mean it's free. Some health benefits in your plan might be "covered in full" which means the costs for your health benefit would be fully paid by the insurance plan that you have. Other benefits might still be covered but are paid for according to your plan's rules for cost-sharing. This would include whether or not you have a deductible to pay on your plan. It's important to note that any amount that you do pay out-of-pocket toward PAP equipment through your plan will go toward paying down your deductible and out-of-pocket max.
Why is my bill so high? Did you forget to submit this to my insurance?
As long as we have your insurance on file and you haven't chosen otherwise, all transactions with Aeroflow Sleep are submitted to insurance. It's important to understand that the amount you may owe for your PAP equipment is set by your insurance company...not by Aeroflow Sleep. Based on your insurance plan, some patients may still owe an out-of-pocket cost. This is usually because you have a deductible to pay off on your insurance account. Upon paying off your deductible, insurance will then split the cost of any healthcare-related items; therefore, decreasing your overall out-of-pocket costs.
Why am I getting a bill when I have an ACH?
You currently have payments setup for your PAP machine; however, your bill that you received is related instead to a new set of fresh supplies.
If I have 2 insurance plans, why do I still owe money out of pocket?
Each plan is different and the way that plans interact is also unique to the coverage that you have. Aeroflow Sleep guarantees that you will get the maximum benefit based on the plans that you have but there are scenarios where secondary insurance will not cover anything. For example, you may have a secondary supplemental plan that only covers co-insurance amounts which means you must meet your primary deductible first before your secondary insurance will help pay for the cost of medical supplies.
I am a patient with Medicaid, why did I still get a bill in the mail?
Not all Medicaid plans are the same. As an example, some Medicaid plans have a "spend-down" which means you must pay a pre-determined amount out of pocket before your Medicaid plan will kick in.
Does Insurance Cover CPAP?
Yes! Most insurance plans (including Medicare and Medicaid) will cover your CPAP machine. They’ll also likely cover your replacement supplies throughout the year. It's important to note that the details can vary from plan to plan, but we can help you find out exactly what your plan covers and determine what out-of-pocket costs (if any) you might incur.
Which CPAP Supplies Will Insurance Cover?
In addition to your CPAP machine, most insurance providers will also cover regular replacement of your:
- CPAP Mask
- Mask Cushion or Nasal Pillows
- Filters (Disposable and Reusable)
- Humidifier and/or Humidifier Chamber
If you’d like to find out how often your insurance provider will cover these supplies, visit your My Account page to see when you are eligible to order your next set of fresh supplies, or click here to read more details about the importance of ordering fresh replacement supplies.
How do I check what my insurance will cover?
Current Aeroflow Sleep patients can always go to the Aeroflow Sleep Reorder Portal to see what items they are eligible to order through insurance at any given time.
Why do I need a prior authorization?
Some insurance providers require prior authorization to ensure that your CPAP equipment is prescribed appropriately. We take care of that for you! If your insurer requires prior authorization, we’ll handle all of the paperwork. You just kick back and wait for your CPAP supplies to be shipped straight to your door.
What is CPAP compliance and why does my insurance require it?
Some insurance providers want you to show that you’re using your CPAP machine before they’ll cover it. We can help you succeed! An Aeroflow Sleep Specialist can help you understand your compliance goals, and offer advice on how to meet them, so you can get the good night’s sleep you deserve!