Chances are, you've never seen or even heard of a CPAP device until you received your prescription to get one.  How do you choose a provider?  How is the device paid for?  The choices you make, either knowingly or unknowingly, can have a strong impact on your success in treating your sleep disorder.  If a patient researches potential providers, most don't even know what questions they should ask.  The following are crucial questions that should be asked of your insurance carrier and the potential provider before you commit to an appointment.

Questions for Insurance Companies

Ultimately, you are responsible for bills associated with your sleep apnea treatment.  Do not assume that your insurance will cover everything.  Before you select a provider, make sure you first check with your insurance company to understand how they will or won't help you out.  We recommend that you make the call yourself, rather than allowing your sleep lab to call on your behalf.  When you call, make sure you write down the name of the representative you are speaking to, as well as the date and time of your call.  Here are some important questions to ask of your insurance carrier:

Is Durable Medical Equipment covered by my policy?

CPAPs and BiLevels fall under the general category of Durable Medical Equipment (DME), which also covers items such as hospital beds, wheelchairs, and oxygen.  In an attempt to contain costs, some employers may select insurance policies which do not include coverage for DME.  If your policy falls in this category, you are going to be responsible for the entire bill from your provider.

Is there an annual deductible, and if so, how much has already been met?

More and more insurance policies have moved to high annual deductibles ($2000 or more), often associated with new tax-free Healthcare Spending Accounts.  Until the deductible is met, the insurance company won't pay a penny.

Does my policy require that I go to a contracted (in-network) provider?

Be careful in understanding their response to this question.  Insurance companies are not necessarily looking to save you the most money.  They are trying to pay out the least they can in order to maximize their profits.  This is often obscured by such phrases as "amount you saved by using a contracted provider."  If your insurance company tells you that you must use a contracted provider, what they are really saying is that they won't reimburse you if you decide to go outside their network of contracted providers.  You can go to any provider you wish, but if your insurance company insists on a contracted provider, it just means that you will have to pay for the equipment and service out of your own pocket.  Most PPO insurance policies allow you to go to any provider you wish, but your out-of-pocket costs vary depending on whether or not the provider is contracted with the insurance company.

While Medicare and many HMO policies which cover Durable Medical Equipment will not pay anything at all if you choose to go to a non-contracted provider, you still may choose that provider if you feel the quality of service makes it worthwhile to pay for the products and services out of your own pocket without any help from your insurance coverage.

Currently, SomniHealth is a registered Medicare provider.  We also accept most PPO insurance policies as an out-of-network provider.  We are in negotiations with several insurers to become a network provider, so please call us at 510.864.4800 to check on the current status with your insurance company.

Is there an In-Network Co-Pay Percentage?  Is there an Out-of-Network Co-Pay Percentage?

Find out the percentage of the bill your insurance company will pay if you choose an in-network vs. an out-of-network provider.  The difference between the two may be smaller than you think.  Co-pays are percentages, so until the dollar amounts charged by alternate providers are known, you cannot determine the best value.

Questions for Durable Medical Equipment Companies (DMEs)

Are you contracted with my insurance?

The answer to this question determines how your insurance will contribute to your bill.  While not contracted with insurance providers, SomniHealth™ can accept your our-of-network benefits.  Alternately, we offer substantial cash discounts for payment in full at time of service.  We will then help you file with your insurance company for direct reimbursement to you, which when combined with the cash discount, can actually save you money.

Do you specialize in equipment for treating Sleep Apnea?

At SomniHealth, we are only focused on providing treatment for sleep apnea.  Everyone on our staff actually has sleep apnea, so you will be working with knowledgeable, sympathetic specialists.

What kind of training will I receive?

SomniHealth has patient rooms large enough to accommodate your entire family, so everyone can learn and participate in your training.  We spend at least 90 minutes with you to select the best equipment for your needs, train you on maintenance, and work through any issues you may encounter.

Can I select the brand and model of my own choosing?

SomniHealth offers top-of-the-line models from ResMed, Respironics, Puritan Bennett, Fisher & Paykel and AEIOMed, at prices that compare to competitors’ basic models.  We even offer a “try before you buy” plan to be certain you have the best model for your needs.

Can I get an Auto-Adjusting Model without an upgrade fee?

SomniHealth offers Auto-Adjusting models at no extra charge. 

How do you select a mask for me?

Mask fit and comfort are critical.  At SomniHealth, you can lie down while wearing various masks, giving you a sense of what they feel like while sleeping.  During your first month, we feature unlimited follow-up visits where you can exchange your mask at no cost until we find the best one for you.

What kind of follow-up care is offered?

Since SomniHealth only sells the top-of-the-line models, we can download data from your device to evaluate the success of your therapy.  Questionnaires offer insight into the improvement to your quality of life.  We even offer overnight oximetry testing to measure the oxygen level in your blood while you sleep with your CPAP/BiLevel to measure the device’s effectiveness.  All this information is shared with your physician(s) to keep them abreast of your treatment.

How much will it cost?

Prices can vary depending on the type of prescription and your insurance coverage, but at SomniHealth, we are happy to provide you with a written estimate in advance of service.  We offer a 25% discount for payment in full at the time of service, and gladly accept Visa, MasterCard, Discover, and American Express.