CPAP Done Right™

We Do CPAP a Whole New Way

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Insurance Information

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.

Prescription Policy

What Makes Us Different

We do not focus on just selling products. Yes, at CPAP Done Right™, we proudly offer CPAP items—the best ones we know of, while offering you the strongest support we know how to give. And yes, our experience has been that the vast majority of our patients succeed with their therapy. But our main focus is on you and your need for a restful, refreshing night of sleep. Click here for more information. Since the 1980s, as the pharmacist-owner and operations manager of CPAP Done Right™, my staff members and I have assisted tens of thousands of folks just like you who have suffered with sleep apnea. For the past five years, I have used CPAP myself. I have worked through many of the same problems and have had to make quite a few adjustments along the way. Since I can identify with what you are going through if you have not yet arrived at a comfort level with your CPAP equipment, I and my staff believe we know what it takes to get you successful with your CPAP therapy. And you can count on us to let you know when improved equipment becomes available or when better interface designs and other accessories are introduced. Further, as far as we can determine, CPAP Done Right™ is the first company local to the DFW area to offer both internet-level low pricing coupled with individualized patient support AND a real brick and mortar store in Denton. Our Denton location has a CPAP fitting lab where we give you one-on-one attention and problem-solving in any area you may have regarding your therapy. We don’t just talk about great support—we willingly give it to you in the way you need it—in person and face-to-face. You just cannot get that from the typical internet CPAP seller website. Internet pricing with a local presence administered by experienced, knowledgeable professionals. We believe that’s the CPAP Done Right™ way to do things.

CPAP Done Right™

2317 W University Drive
Suite 101B
Denton, TX 76201
940-808-1680 local or 1-855-396-2931

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