Does Insurance Cover Travel CPAP Machines?

  • By Clay Rollyson
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When you have insurance, you certainly want to use it where you can. Travel CPAP machines are no exception. With that being said Travel CPAPs can be difficult or impossible to have covered by insurance. Below are some things to consider as you start looking for a Travel CPAP.

Does the Travel CPAP have PDAC coding?

The Pricing, Data Analysis Coding (PDAC) is where items that can be billed to insurance are listed. Manufacturers have to submit their products for review and approval to have their product coded for insurance billing. Many of the Travel CPAP manufacturers have elected not to have their unit added to that list. So, in those scenarios, you cannot have your Travel CPAP billed to insurance. You can look at the listings here to see if the Travel CPAP you are interested in has coding for insurance coverage.

Have you had another CPAP already covered by Insurance?

If insurance has already paid for a home CPAP in recent history, then most likely they will not cover another CPAP. For instance, Medicare typically covers a new CPAP every 5 years. In that scenario, you would not be able to have Medicare cover your Travel CPAP within 5 years of the first CPAP. Many other insurance carriers have a similar time frame for covering new CPAPs.

Where do I get a Travel CPAP if it is approved by insurance?

Finding a CPAP provider that is “in network” with your insurance and will also provide the specific Travel CPAP that you want may be difficult. That is because most Travel CPAPs are much more expensive on the wholesale side that the Home CPAP Machines. Insurance will only reimburse a certain amount to that provider regardless of which make, and model CPAP is provided. That means that most insurance providers do not even carry Travel CPAPs. To find out you would want to reach out to your insurance company and ask for a list of “in network” CPAP providers. Then reach out to those providers and ask them if they carry the specific model that you are looking for.

Can I submit a claim for a Travel CPAP after I pay cash for one?

In many cases you can. To begin that process you would want to contact your insurance company and request an “out of network” claim form. Then you can submit your claim form and details from the supplier you purchased the Travel CPAP from. If you have “out of network” benefits, then you may be reimbursed. It never hurts to find out.