Paying Out of Pocket versus Using Insurance for CPAP Supplies?

Ever Wonder Why Doctors Take Vacation in July?

I saw a major trend every year during the summer months at the sleep disorders center I worked for as a Director of Lab Operations.  Referrals were down and patient schedulers’ were feverishly making phone calls to patients to try to get them in for follow up appointments and re-evaluations.  Ever go to your doctor’s office in July and see tumbleweeds blowing through the waiting room and ask yourself if you missed the zombie apocalypse? Where did everybody go? Everyone can’t be on vacation at the same time can they? An apple a day may keep your doctor away but a July healthcare insurance deductible rollover WILL keep patients away.

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Leave a Little Extra in Your Wallet This Year. Shop 1800CPAP.com

Insurance policies that have a July deductible rollover are becoming a common trend and what that means is on July 1st of every year, your deducible goes back to zero.  Simply meaning, you have to meet your deductible “again” before you 80 or 90% of coverage will begin.  Every month we pay premiums towards our healthcare coverage, that warm and cozy little blanket that makes us feels safe just in case something bad happens. Unfortunately, a lot of us that rarely use our medical insurance tend to opt for the policy that has a high deductible to keep our monthly premiums low and affordable and hold our breaths that we will not need to use it. What about those of us that use CPAP (continuous positive airway pressure), a device used to keep our airway open while asleep?

People that suffer from sleep apnea are most commonly prescribed a PAP device (Auto CPAP,  or Bi-Level) and these devices and accessories require parts and replacements that should be replenished every 1-3 months or as needed.  This translates into a billing of CPAP hose tubing ($45.00 billable insurance rate), mask ($120.00 to $190.00), headgear ($45.00), filters ($9.00), water chamber tubs ($30.00), and maybe a chinstrap ($20.00). If the average single person deductible is $2000.00 before coverage kicks in (and then maybe only 70-80% is covered) then you are paying all of this out of pocket until your deductible is met.

Cost Comparison of CPAP Items Billed Through Insurance versus Self Pay Purchase

Remember that you are responsible for all costs out of pocket until your deductible has been met and then you may only be covered at 60%-80% of the cost.

Item

Cost Billed Through Insurance

Cost at 1800CPAP.com

CPAP   or Auto CPAP

$2000.00

Starting   at $275.00

Bi-Level   or BiPAP

$3500.00

Starting   at $995.00

VPAP   Adapt or Auto SV

$6500.00

Starting   at $3500.00

Heated   Humidifier

$450.00

Starting   at $129.00

Full   Face CPAP Mask

$190.00

Starting   at $119.00

Full   Face Mask Cushion

$75.00

Starting   at $49.00

Nasal   Mask Cushion

$45.00

Starting   at $26.00

Nasal   Pillow Cushions

$30.00

Starting   at $10.00

Nasal   CPAP Mask

$120.00

Starting   at $39.00

Mask   Headgear

$45.00

Starting   at $18.00

Chinstrap

$20.00

Starting   at $14.99

Hose   Tubing

$45.00

Starting   at $8.99

Filters,   Disposable

$6.00

Starting   at $3.00

Filters,   Non-Disposable

$20.00

Starting   at $4.00

Replacement   Water Chamber

$30.00

Starting   at $19.99

Where can I get Affordable CPAP Supplies?

Self paying (meaning you pay out of your own pocket) using health equipment providers that DO NOT have contracts with insurance companies is the most affordable method since we are not obligated to charge you insurance billable rates. What that means is, if we accepted your health insurance we would be obligated to charge you the rates that are billed, but since we do not, we can set our own price levels.  The same CPAP tube hose that we sell for $8.99 sounds so much better than one that may cost you $45.00 doesn’t it?  Not to mention, some insurance companies require a prescription for that tube, so add a co-pay into the equation and it simply doesn’t make sense.

New CPAP Users

Even if you have been recently diagnosed with sleep apnea and prescribed a therapy device a direct purchase from 1800CPAP.com for a machine starting at $275 is much less out of your pocket than the $200/month for 10 months a HME (home medical equipment) provider will charge you through insurance.  The traditional DME (durable medical equipment) companies like to argue that support and fittings make them a better option for you than using an internet CPAP dealer but all too often they fail to realize that we live in a digital age where printable fitting guides, online live chat, phone support and PDF downloads put more information at your fingertips than ever before. I personally have spent many years on both sides of this argument and know that 1800CPAP.com offers just as much support if not more than traditional “brick and mortar” DME shops.

So put some of that money back into your own pocket and take that dream vacation next July.

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