Traditionally there have been two different kinds of companies who provide CPAP products: those who bill third party payers (Medicare, private insurance, etc.) and those who do not.
1. It is well known in our industry that it is very costly to file insurance with the detail that third parties require–to assemble the supporting documentation, to file follow-up and/or appeals to the claim, deal with audits, and then wait weeks for payment. Such filing and free-financing costs have to be supported by the price the provider charges. Companies of this type generally offer what they believe to be great product and service support, but they typically charge top-dollar prices since they must make a profit. Unfortunately, they are prohibited by Medicare laws and regulations from offering special price promotions and discounts, since it would be considered to be inducement for referral to do so. Some private insurance companies have similar restrictions.
2. The other type of company is one who does not participate in this third party payment process, but who instead accepts credit card or cash payment for their products and services. By being a cash business, they bypass costly billing expenses and can therefore sell the same products at lower prices. Unlike providers who accept insurance, they are free to offer promotions and discounts and frequently do. However, this type of company usually is an internet-based retailer; i.e., one without a retail brick and mortar store that patients can visit. These internet stores sometimes do not live up to their promises of wonderful follow-up support. Some discourage you from making further contact with them, unless you want to buy something else from them. Others provide customer service that can best be described as skimpy.
3. A New Category—A CPAP Value Model Company
At CPAP Done Right™, we fit into third category that as far as we know is unique: CPAP Done Right™ is a Value Model CPAP business. We do not have a Medicare or Medicaid provider number, nor do we accept assignment on third party billing. As in the example in “2” above, we offer unbeatable pricing, matching or beating all legitimate online e-commerce sites. However, unlike other online providers, we actually encourage people to visit our brick and mortar store so that they see us face-to-face. We don’t believe there is any substitute for in-person contact by the patient with our staff. Giving the CPAP patients our full attention in our own CPAP fitting lab, we will demonstrate the various products we offer and counsel with them so that they can make a well-informed decision as to which products best fits their needs and preferences. We have over 30 years of experience of providing CPAP with this business model in our sister company, ActivMedical, a traditional brick and mortar store. We are convinced that this approach is the key to the high rate of CPAP patient success we have come to be known for—well over 80% (industry average is only about 55% at best). So, come to Denton to see us. Our goal is to make it well worth your trip.
When you are filing your insurance claims yourself, insurance companies usually do not hold you, the policy holder, to as high a standard of supporting documentation as they do for a CPAP supplier who is filing a claim to have payment sent directly to them. Here is what you do: When you purchase your CPAP equipment from CPAP Done Right™ we will supply with a detailed receipt, which has an itemized list of your purchases and the prices you paid for them. Use the coding system below to assign the proper procedure codes to those items. Then, submit your claim to your insurance company by attaching your receipt, along with a copy of your current doctor’s order. When your claim is approved, your insurance company will send the check directly to you.
For the many folks these days who, because of high insurance deductibles and/or co-pays, are in the position of having to pay for CPAP items from their own funds, we are the perfect place to shop: a store with internet-level pricing that has a brick and mortar store staffed with experienced people who really know their stuff. On the other hand, if you already know what you want, you can choose the items you want and have them shipped directly to your door. Either way, you won’t be able to beat our Value Model pricing and service policy at CPAP Done Right™.
Below are CPAP items with specific Health Care Procedure Coding System (HCPCS) for your convenience, along with manufacturer’s change-out frequency, which are recognized as being medically reasonable by most insurance plans:
|Description||HCPS Code||Replacement Frequency|
|Full Face Masks||A7030||1 every 3 months|
|Replacement Cushion for Full Face Masks||A7031||1 every month|
|Nasal Masks||A7034||1 every 3 months|
|Replacement Cushion for Nasal Mask||A7032||1 every 3 months|
|Replacement Nasal Pillows||A7033||1 or 2 every month|
|Headgear Mask, any type||A7035||1 every 6 months|
|Patient Tubing||A7037||1 every 3 months|
|Heated Patient Tubing||A4604||1 every 3 months|
|Disposable Filter||A7038||2 every month|
|Reusable Filter||A7039||1 every 6 months|
|Distilled Water Chamber||A7046||1 every 6 months|
|CPAP Blower Unit||E0601||1 every 5 years|
|Heated Humidifier Unit||E0562||1 every 5 years|
|Bi-Level Respiratory Assist Blower Unit||E0470||1 every 5 years|
|Bi-Level Respiratory Assist Blower Unit with Pressure Support||E0471||1 every 5 years|
|Bi-Level Respiratory Assist Blower Unit with Timed Back-Up||E0471||1 every 5 years|
NOTE: You should know that, regardless of brand and model, full-face, nasal or nasal-pillow masks are sometimes sold as sets. There are three distinct billing codes with three different HCPC codes that, taken together, comprise the set: the mask itself (see A7030 or A7034 above), the interface for the mask (see A79031 or A7032 or A7033 above) and a headgear (see A7035 above). Any of the three (mask, interface or headgear) may be sold both as a set and separately in each of the three pieces. At CPAP Done Right™, you pay the same price either way; i.e., the sum of the prices of the individual parts is exactly the same as for the whole set.