Insurance Guide

Most insurances and Medicare cover PAP supplies, including masks, headgear, tubing, filters, humidifiers, and replacement pillows and cushions. Regular supply replacement is recommended and allowed under Medicare and most other insurances.

 

Your insurance company has guidelines for beneficiary receipt of PAP devices and sleep apnea related equipment, giving you the opportunity to replenish your equipment regularly through PHC. If you do not meet these requirements, you will be financially responsible for the payment of the machine and supplies.

 

Continued Coverage

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   Supply Item                                Common Frequency Limits

Full Face Mask                                     1 per 3 months

Full Face Cushion                                1 per month

Nasal Mask                                          1 per 3 months

Nasal Cushion/Pillow                           2 per month

Headgear                                            1 per 6 months

Standard Tubing                                  1 per 3 months

Heated Tubing                                     1 per 3 months

Filters                                                   2 per month

Foam Filters                                         1 per 6 months

Water Chamber                                    1 per 6 months

Chin Strap                                            1 per 6 months

 

Many insurance companies, including Medicare, will continue to cover your PAP and supplies past the initial 90 days. However, it is necessary that you revisit your doctor between the 31st and the 91st day after initiation of your PAP therapy, so your physician can conduct a re-evaluation. This is to ensure you are receiving benefit from your PAP therapy. If you do not meet these requirements, you will be financially responsible for the payment of the machine and the supplies.

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Our CPAP Resupply Team will contact you when you are eligible for supplies.

 

Please call PHC at (843) 762-1177 with any questions or concerns.

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