Insurance & Medicare
Checklist for your physician
For Your FYI
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.
“ Great people and service!” Tommy B. , Greece
Health Insurance Plans We Accept
Medicare and Medicaid
Independent Health (IHA)
Excellus and BC/BS WNY
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?
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.
- Continuous Positive Airway Pressure (CPAP) devices
- Nebulizers & nebulizer medications
- Oxygen equipment & accessories
- and more visit https://www.medicare.gov/coverage
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.
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
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 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.
El Internet es una gran fuente de información que usted puede utilizar para el cuidado de su salud o la de un ser amado. Puede ser también una buena manera de localizar los recursos de apoyo que usted necesita como paciente o cuidador. Abajo se encuentra una lista de...
Before you pick up the phone to speak to a claims representative, you need to gather some information. Be prepared to give the person you talk with: Your name and your relationship to your care recipientYour care recipient’s birth dateThe insurance policy numberThe...
The Internet is a great source of information for you to use in managing your healthcare or the healthcare of a loved one. It can also be a good way to locate the support resources you need as a patient or caregiver. Below is a list of links which we hope will help...
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