How Often Can I Get a New CPAP Machine?

Like iPhones, CPAP machines have changed a lot over the past few years. The latest models are even starting to look like Apple devices. These changes in the form and function of CPAPs serve very important purposes.

(1) If a CPAP machine is more attractive and user-friendly, someone diagnosed with sleep apnea is more likely to use it.

  • They’re quieter and smaller.
  • It’s easier to turn on and off (many turn on automatically once you put on the mask and start breathing).

(2) If the technology allows for wireless transmission of usage data, the CPAP supplier (for some of you that might be us, learn more about “smart machines” here) doesn’t have to hassle patients for smartcard download. When compliance data is required by the insurance company, the provider can easily access the data (here’s a post where we talk about our process).

  • Your CPAP supplier can help you troubleshoot when you’re having issues with therapy. They can even adjust the settings remotely on some machines.
  • You have access to your usage data, either online or on an app. Knowledge is power.
  • If/when your insurance company requires proof of usage for your device rental or purchase or when it’s time for new supplies, your supplier can easily obatin the info and send it directly to the insurance company. No need to mess with shipping cards back and forth.

(3) New devices are better at treating sleep apnea. That’s a big deal.

So, now that you want a new machine, you’re going to ask, “How do I get a new CPAP?”

How Often Will Your Insurance Cover a New CPAP Machine?

It varies insurance by insurance; however, if you’ve had your machine for 5 or more years or your machine is in poor working condition, you may qualify for a replacement. You will need a new prescription from your physician and documentation of a face-to-face evaluation stating that you are still using and benefiting from therapy. If you have HMO insurance, your physician may need to request authorization from your medical group (learn more about insurance requirements for CPAP here).

If your device is broken (and no longer covered under warranty) or stolen, your insurance may approve a new device even faster.

Check with your CPAP supplier to discuss next steps.

Will I need a new sleep study to get a new device?

Again, it depends on your insurance. 

Typically, you will only need a new sleep study for one of the following reasons:

  1. Your symptoms return. If the symptoms that lead you to get tested and start therapy (snoring, gasping at night, daytime sleepiness) return, you should talk to your doctor about evaluating your sleep problems and potentially changing your machine pressure.
  2. Your symptoms don’t go away. If you start therapy but your symptoms remain, you may need to be tested again to evaluate for another sleep disorder or to adjust your machine pressure.
  3. Weight gain or weight loss (this is one of the most desirable side effects of CPAP therapy). Weigh gain can increase the severity of sleep apnea and weight loss can reduce or even eliminate events. If you’ve had a significant weight change you should evaluate your pressure settings.
  4. Other major health changes. Stroke, heart attack or other cardiac issues since starting therapy or if you’ve started using nocturnal oxygen, may mean that you need a new sleep study.

If you’re interested in learning about getting a new CPAP device, contact us to find out about your insurance coverage or our cash rates. We’re contracted with most commercial health insurance and medical groups (HMOs).

See our list of contracted insurances

Request a CPAP set-up

Shop CPAPs and supplies online

Sources:
http://www.resmed.com/us/dam/documents/articles/DoIqualifyforanewCPAPmachine.pdf 

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Comments

  1. Steve Avila Reply

    I did a PSG in 2007 and have been using a machine since then. I want to upgrade my machine but am told I need a prescription. I haven’t been to my doc fo 6 years so they wanted me to come in for an exam. I just want to keep using a CPAP machine and what I have works….I just want to new version that is smaller and automated. Is there a way to upgrade the machine without going through all of this? Can my current machine be tested for pressure or can I do a home study? I definitely need the machine but thought I could just upgrade without all the other red tape.

    Steve

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