Our Experience With CPAP Insurance and Copay Differences

I've been using my CPAP (continuous positive airway pressure) machine for 7 years now. Well, 6 years; I haven't been able to use my machine this entire year. Hopefully, that will change here shortly. During the wait for my new CPAP, my husband was also diagnosed with sleep apnea. When ordering his new machine, we learned more about CPAP insurance and copays – they vary. "Now, something just doesn’t seem right here!"

CPAP insurance and copays

Provider issues

Anyway, my CPAP machine was $1600.00 out of pocket. (By the way, I had really good insurance!) From the local company I bought it from, I had to have insurance to even order 1. They also only sold 1 type of machine. Of course, at the time there were only 2 companies locally. I don't know how the other company worked. Looking back, I probably should have at least talked to somebody at this other place.

Although I could have also ordered a CPAP machine online, I didn't know how reliable these companies were. These machines could be purchased with or without insurance.

Getting a CPAP ordered

All of this was new to me. I had no clue how to actually get 1 ordered. To be quite honest, it was kind of unnerving. I do remember before the sleep study, there was paperwork to fill out that included asking where I wanted to purchase my supplies.

When I finally got brave enough to call, I found out that the neurologist had already ordered my machine right from the same company I said I would be getting supplies from!! They had made arrangements and said it all right there. I missed that clue by a long shot!! I do wish that someone would have explained this to me. It could have helped with my nerves.

Thankfully, they very sweetly explained that my machine would be there in the next few days. And at that time, they would call me. So, I could come in and get fitted for the mask – along with a little training on how to use the machine.

Why am I sharing this?

The reason I'm thinking about all this now is that my husband just got diagnosed with obstructive sleep apnea (OSA). So, I kind of helped, and guided him through the process. By the way, no one explained to him about the doctor actually ordering it either.

Differences in CPAP copay

But, he was given the choice to run it through insurance. Or, pay for it right out of pocket!!

Here's, the catch: if it went through insurance, his CPAP machine would cost $1600, which would be the copay! Also, it was required to wear the CPAP at least 4 hours a night or insurance would require him to pay the full price of the machine. Which would be another $1600.00. (OK… now that seemed reasonable to me because that's kind of what I had to do.)

However, my husband was given the option of paying $600 cash with no insurance involved!! What? Also, they included a choice of how many hours a night to use it. I personally, no joke, would choose at least 7!!

The company's explanation

Apparently, this company did not see the fairness of charging people that were incarcerated $600. While leaving everyone else to pay the $1600 – with or without insurance!

Um… gotta be honest, I wholeheartedly agree!!

I'm not rich. It took quite a bit of planning to get that amount of money on short notice to pay for a medically needed device.

I just thought I'd share that information. For anyone who does need a machine and struggling to pay for 1. Remember, talk to your provider!!

Was there a copay for your CPAP machine? Please share a comment.