If you’ve been recently diagnosed with sleep apnea and require CPAP (Continuous Positive Airway Pressure) therapy, you may be taken aback by learning about the cost of the machine and supplies.The following outlines some useful information on how to go about navigating insurance, payment options, and government supports available in order to successfully start your CPAP therapy:
Is sleep apnea treatment covered by insurance?
Many health insurance companies cover CPAP equipment, however, the level of coverage and rules for coverage will depend on your specific insurance policy. Review your insurance policy to determine if, and to what extent, your CPAP equipment is covered.Typically, insurance providers will require the diagnosis from a sleep test, in addition to the prescription for CPAP therapy from a physician.
Sleep apnea testing determines the number of pauses in breathing, plus the number of shallow breaths while asleep. Some insurance providers require a minimum AHI (Apnea-Hypopnea Index) to cover CPAP therapy.
An AHI:
- Less than 5 is normal
- 5 – 15 is mild
- 16 – 30 is moderate
- Greater than 30 is severe
Questions to ask your insurance provider:
- Am I covered for CPAP therapy? If so, what is the criteria based on? (For example, some insurance providers have requirements on the severity of diagnosis)
- Do I have full or partial coverage and what is the percentage covered? What is the maximum?
- Does my coverage include masks, hoses, and other accessories I might need?
- How often am I covered for a new CPAP machine?
- How often am I covered for a new mask and other supplies?
- Do I have to pay out-of-pocket for the CPAP and submit my receipts for reimbursement, or can it be directly billed to the insurer?
- What paperwork is necessary to complete the claim?
Please note that some insurance providers request a quote for the cost of the CPAP machine and supplies once you have submitted a claim. In general, this is optional and not a requirement. The benefits your insurance provides are determined by your coverage outlined in your specific plan, not based on a quote.
Purchasing through your own means
If you do not have insurance or your insurance only covers a portion of the CPAP machine and supplies, Aveiro Sleep has several ways to help make the financial output more manageable:
- Different package levels – Aveiro Sleep offers a variety of options from a basic set-up to a top of the line bundle. Whatever the package choice, all CPAP machines sold through Aveiro Sleep are high-quality, provide excellent therapy effectiveness, and have a 3 -year warranty. As an additional value, Aveiro Sleep provides service for life with purchase of a CPAP machine. This means no fees for follow-up visits and support.
- Monthly payment plans – Breaking up the payment into smaller portions is a good solution for those who are unable to pay the entire amount all at once. Aveiro Sleep works with patients in creating individualized plans that help the cost be more manageable.
- Compassionate Care Program – Unfortunately, the price of a CPAP machine may be a barrier to receiving treatment. Aveiro Sleep recognizes this need and has developed a program to assist those who have exhausted all avenues of funding.
- Financing through Medicard – Company who specializes in providing financing for medical equipment and treatments. This is a convenient option for those who want to start their CPAP therapy right away, those who don’t own a credit card, and those who want to split their purchases into monthly payments. For more information about Medicard, please visit https://www.medicard.com/.
Is CPAP covered by Alberta Health?
Currently CPAP therapy is not covered by Alberta Health. Below are opportunities for government assistance with CPAP therapy funding. Each program has their own requirements and criteria, please contact them directly for information.
- Alberta Works – Support for individuals and families to pay for basic expenses like food, clothing, and shelter. For more information please visit https://www.alberta.ca/income-support.aspx.
- AISH (Assured Income for the Severely Handicapped) – Financial and health benefits for eligible Albertans with a permanent medical condition that prevents them from earning a living. Contact AISH for more information please visit https://www.alberta.ca/aish.aspx
- Special Needs Assistance for Seniors – Seniors with low-income can get financial assistance to help afford the cost of appliance and specific health and personal supports. For more information please visit https://www.alberta.ca/seniors-special-needs-assistance.aspx.
Other considerations:
- Although CPAP machines are expensive at the start, they are used every day and over several years.
- Taking a holistic view, CPAP therapy has positive effects on overall health and associated conditions. It can reduce blood pressure, risk of stroke, improve memory, and improve insulin sensitivity, among many other benefits.
- Purchasing your CPAP machine from Aveiro Sleep gives you a lifetime of service with no fees, remote monitoring for therapy effectiveness, pressure adjustments anywhere within cellular range, machine warranty, mask guarantee, and professional support.
Aveiro Sleep provides Home Sleep Apnea Testing, CPAP therapy and support services catered to obstructive sleep apnea. Our local clinics allow us to test, treat, and support thousands of Albertans close to their homes.
Call now to speak to a Patient Success Coordinator 1-855-852-2989 or contact us through our online form.