It’s All About You
“ Great people and service!” Tommy B. , Greece
We’re here to help
Getting the equipment you need to stay healthy can be intimidating when it comes to health insurance, terminology and paperwork. You may be wondering “Does my health insurance cover CPAP?” At Rochester Oxygen and CPAP our team is dedicated to help every single patient overcome the red tape and get back to living healthy. We treat our patients as if they were our own family members. We’ve been around so long because word of mouth is our best marketing and we strive everyday to earn our amazing reputation.
This page is meant to be a resource to you. However, you can pick up the phone and talk to someone anytime for your specific questions. It’s our goal to make getting your medical equipment as speedy and easy as possible.
Our staff has years of experience dealing with insurance carriers and healthcare professionals. Let us help you navigate the process without hassle so you can get back to your life. Your best life is our mission.
You
Documents
Patient's Rights and Responsibilities
Medicare Supplier Standards
About Our Family Of Companies
Emergency Preparedness
Phone Number Resouce Guide
Our Privacy Policy
FYI
COMPLIANCE
Most compliance periods last for 90 days. To be considered compliant a patient must use their sleep therapy device for more than 4 hours a day and 70% of a 30 day period..
- This equates to a minimum of 21 out of 30 days. To be counted a machine must be used a minimum of four hours per day.
- A patient who uses their machine for 3 hours per day 21 days in a 30 day period is considered 0% compliant.
- A patient who uses their machine 4+ hours per day for 21 days in a 30 day period is considered 70% compliant.
- The four hour minimum is counted cumulatively, not consecutively – patients who sleep with their machine for one hour in the afternoon then three hours at night meet their four hour requirement for that day.
AN FYI: WHAT IS LCD?
A local coverage determination (LCD) is a decision made by a Medicare Administrative Contractor (MAC) on whether a particular service or item is reasonable and necessary, and therefore covered by Medicare within the specific region that the MAC oversees. Learn more here
CareCredit
CareCredit helps you pay for out-of-pocket healthcare expenses for you, your family, and even your pets! Once you are approved, you can use it again and again* to help manage health, wellness and beauty costs not covered by insurance.
Your Health Care Professionals
You have the right to choose your CPAP equipment provider, just ask for us!
Your Doctor’s Checklist For Insurance
WRITTEN ORDER PRIOR TO DELIVERY (WOPD) INCLUDES
- Order Date
- Patient Name
- Detailed Description of items ordered
- Practitioner NPI
- Practitioner Signature
DIAGNOSTIC SLEEP STUDY
Within 12 Months of order date
FACE-TO-FACE WITHIN 6 MONTHS PRIOR TO THE WOPD DATE
If face-to-face prior to diagnostic study is within 6 months of WOPD date, then no new face-to-face is needed.
IF BIPAP (E0470) ORDERED, NEED CPAP/BIPAP TITRATION STUDY
Shows CPAP pressures insufficient and BIPAP pressures required.
PATIENT HAS FOLLOW-UP VISIT SCHEDULED
PRINT THIS CHECKLIST
Download it here and bring it with you to your next visit.
Health Insurance
Insurance Plans We Accept
Medicare and Medicaid
Independent Health (IHA)
Excellus and BC/BS WNY
United Healthcare
Aetna
Univera
Private Pay Financing Available Through CareCredit
Medicare
The Different Benefits of Traditional Medicare
Medicare Part A benefits cover hospital stays, home health care and hospice services.
Medicare Part B benefits cover physician visits, laboratory tests, ambulance services and home medical equipment.
While oftentimes you do not have to pay a monthly fee to have Part A benefits (you only have to pay money when you use the services), the Part B program requires a monthly premium to stay enrolled (even if you do not use the services). In 2017 that premium was $134 per month (but could be less) depending on your income. Typically, this amount will be taken from your Social Security check.
Medicare Part D offers optional program benefits that cover prescription drugs.
For more information about your benefits or making coverage decisions, you can visit the official website for Medicare benefits at www.medicare.gov.
What’s Covered Under Medicare For CPAP Therapy?
Sleep Studies
Medicare Part B (Medical Insurance) covers Type I, II, III, and IV sleep tests and devices if you have clinical signs and symptoms of sleep apnea.
You pay 20% of the Medicare-approved amount after you’ve met your Part B deductible.
CPAP Equipment
- Continuous Positive Airway Pressure (CPAP) devices
- Nebulizers & nebulizer medications
- Oxygen equipment & accessories
- and more visit https://www.medicare.gov/coverage
If your supplier accepts assignment you pay 20% of the Medicare-approved amount, and the Part B deductible applies.
Oxygen equipment & accessories
Medicare Part B (Medical Insurance) covers the rental of oxygen equipment and accessories as durable medical equipment (DME) that your doctor prescribes for use in your home when all of these conditions are met:
- Your doctor says you have a severe lung disease or you’re not getting enough oxygen and are in a chronic stable state.
- Your health might improve with oxygen therapy.
- Your blood oxygen level falls within a certain range.
- Other alternative measures have failed.
If you meet the conditions above, Medicare helps pay for:
- Systems that provide oxygen
- Tubing and related supplies for the delivery of oxygen and oxygen contents
You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
For more resources and information about Sleep Apnea and CPAP, read the articles below or visit SleepFoundation.org
Sleep Apnea In Women
With many health conditions, women can be affected differently compared to men. This is the case with sleep apnea, which affects around two or three times1 as many men as it does women. It's only in recent years that more attention has been paid to the role of gender...
FDA Approves Lumin For Mask Sanitizing
3B Medical announced on Monday, December 7th that they have received Emergency Use Authorization from the FDA to permit the use of Lumin, a UVC system, on N95 respirators during the COVID-19 pandemic. Lumin was designed to clean CPAP accessories but can also be used...
Sweet Dreams
Maureen Kemeny, owner of Lifeswitch Inc., is a Certified Health and Wellness Coach and an Essential Oil Educator with a Masters in Psychology.
Sleep Diet
Jessica Bennett, MS, RD, CDN is a Registered Dietitian Nutritionist who helps individuals and groups manage weight, health, food sensitivities, and other nutrition concerns. She believes that food is our first medicine and our health and sleep can be drastically...
Mindful Eating
Jessica Bennett, MS, RD, CDN is a Registered Dietitian Nutritionist who helps individuals and groups manage weight, health, food sensitivities, and other nutrition concerns. She believes that food is our first medicine and our health and sleep can be drastically...
Our Commitment To You
Wherever. Whenever.
We have four convenient locations in the Rochester area to help you with oxygen and sleep therapy. Our professional, friendly staff is ready to help you find the right equipment and overcome challenges.
Brockport
22 N. Main Street
Brockport, NY 14420
Phone: 585-334-0200
Fairport
6687 Pittsford-Palmyra Rd.
Fairport, NY 14450
Phone: 585-334-0200
Greece
2844 W. Ridge Rd
Rochester, NY 14626
Phone: 585-334-0200
Rochester
1425 Jefferson Road
Rochester, NY 14623
Phone: 585-334-0200