Durable Medical Equipment (DME)

Frequently Asked Questions:

Will my insurance pay for CPAP/BIPAP?
CPAP is covered under a benefit called Durable Medical Equipment (DME). Most insurance companies provide a DME benefit, but often the deductible for the calendar year must be met before the insurance will pay. Your insurance company or CPAP supplier (DME) should be able to provide this information for you.

When will I own my CPAP?
Most insurance companies require a rental period which is usually 1 to 13 months long before the machine is considered purchased. Also, your machine contains a card/chip which monitors your CPAP usage and the effectiveness of your therapy. Your insurance company uses this information to determine whether or not to pay for your CPAP machine. Compliance is generally considered to be at least 4 hours per night, at least 70% of nights in a 30 day period. Most insurers will give you 90 days in which to achieve this goal.

Can I choose my DME company?
Yes, BUT – some insurance companies have contracts with DME companies. If you got out of the network, you may have financial consequences such as higher co-pays and deductibles.

How often can I get new supplies?
• Filers, mask cushions/nasal pillows – two items every 30 days.
• Masks and tubing – every 3 months.
• Headgear, humidifier reservoirs, chinstraps – every 6 months.

Does my CPAP have a warranty?
Most CPAPs have a 2-year warranty; most BIPAPs are one year.

When am I eligible for a new CPAP?
CPAPs can be replaced no sooner than 5 years from set-up with insurance companies. New units will be provided for those moving from one type of therapy to another (CPAP to BIPAP). A non-functioning, non-repairable unit may also be replaced. Most insurers will NOT reimburse for a new CPAP because of new features, new technology, or decreased noise level unless it has been over 5 years from the last set-up. Simply having a physician’s order for new equipment does not ensure that your insurance company will pay for it.

CPAP Equipment Cleaning:
If the mask is completely clean, it will seal better. Wash the masks every few days with a few drops of dish detergent such as Dawn. Be sure to rinse completely. Use hot, soapy water to clean the water reservoir and tubing. Using distilled water in your humidifier cuts down on the cleaning. Open the reservoir and air dry them frequently. Remember – dark, moist environments grow things you would probably not want to breathe! Equipment should be washed at least once or twice a week. Don’t forget to wash the washable filters weekly and change the disposable filters monthly. Breathing through a dirty filter is worse than using no filter!

*Other DME options are available, but these are the most commonly used