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Insurance Overview and FAQ

What insurance does Easy Breathe accept?

Easy Breathe is one of the only online CPAP providers able to bill insurance. We work with most private PPO plans, including all of the major insurance carriers below:

 

 

Private Insurance Carriers

 

 

Easy Breathe works with your PPO plan as an out-of-network provider. This allows us to help CPAP patients with different insurance carriers in all 50 states, instead of being limited to one service area. Many PPO type plans have excellent out-of-network coverage, and many of our patients end up paying the same or even less with us than with an in-network provider.

 

Not sure what your insurance covers? Everyone's insurance plan is different. Easy Breathe will be happy to call your insurance company for you to check how much they will cover with us. Click the button below to request a free, no-obligation verification.

 

 

 

Medicare and Other Providers

Healthcare provided through the government, such as Medicare, Medicaid, and TRICARE, only work with a limited number of providers that have contracts with them. While we are not able to bill these types of plans, we do what we can to help these patients through discounts and our convenient cash-pay service. To find a provider that can work with these services, call the phone number on your card.

 

Over 20,000 of our customers are eligible for Medicare. Even though we can’t bill Medicare, CPAP users like you prefer the convenience and customer service that Easy Breathe provides. We offer all the most popular supplies, such as CPAP masks, without a prescription. Call (866) 564-2252 for the 15% coupon code we offer exclusively to Medicare recipients.

 

 

 

 

Calculating Your Responsibility

Many people going through their insurance worry about getting stuck with the bill after receiving their equipment. Unlike many out-of-network providers, Easy Breathe does not balance-bill patients for the amount that their insurance company denies or does not cover.

 

We do the work up-front to calculate your part of the cost based on your deductible and coinsurance, and you pay your responsibility at checkout. Then we file the claim with your insurance for the remaining cost. Even if things do not work out as planned with your insurance company, we will never send you an additional bill for that order once it is shipped.

 

The only circumstance in which a second invoice will be sent to you is if the insurance company mails the payment check for your order to you instead of to us - which sometimes happens because we are out-of-network. This payment check is the portion of your order cost that your insurance carrier agreed to cover. In this case, we will only invoice you for the amount of the check that you are depositing on our behalf. Alternatively, you can always contact our billing department and mail that check to us instead.

 

You may notice two prices for items on our website. Your responsibility is calculated based on the discounted "Cash" price of your item(s) on our website. "Retail Price" is the price that we will charge your insurance carrier. The Retail Price is the greater of the Medicare Allowable Amount (maximum amount Medicare will pay for a covered health product) or the Manufacturer Suggested Retail Price. This higher amount covers a host of additional expenses associated with billing and collecting from insurance carriers, including, but not limited to, claim submission, documentation gathering, collection efforts, appeals efforts and write-offs of uncollectable claims.

 

If you have any questions about our billing practices, please email [email protected] and your inquiry will be forwarded to our billing department.

 

 

 

 

Insurance Requirements

Here is what we need in order to verify your insurance coverage: 

  • - Your insurance Member ID 
  • - Your Date of Birth

After getting you a quote for your insurance benefits, Easy Breathe will help you contact your doctor's office for the following: 

  • - A prescription for CPAP equipment
  • - Any additional medical records, such as your sleep study, that your insurance company requests.
  • - Your signed Assignment of Benefits Agreement, which allows us to accept payment for the equipment from your insurance. 

 These documents are needed in order to show medical necessity to your insurance company. But don't worry - our team will handle the legwork in getting them to your insurance company. Click the button below to submit your insurance information to us and get started!

 

 

 

 

Insurance Eligible Products

Many CPAP users are unaware that their insurance covers not only their machine, but also the supplies that they go through each month.

 

Almost all private insurance companies follow the same replacement schedule set by Medicare for how often they will cover new equipment. See the chart below to see how often insurance will cover different parts:

 

Mask Replacement Part Code Schedule
Nasal Pillows A7033 2 per month
Nasal Cushions A7032 2 per month
Nasal Pillows for Hybrid Oral/Nasal Mask A7029 2 per month
Full-Face Cushions A7032 1 per month
Mouth Cushion for Hybrid Oral/Nasal Mask A7028 1 per month
Full-Face Mask Frame A7030 1 per 3 months
Nasal or Nasal Pillow Mask Frame A7034 1 per 3 months
Hybrid Oral/Nasal Mask Frame A7027 1 per 3 months
Mask Headgear Straps A7035 1 per 6 months
Chinstrap A7036 1 per 6 months

 

CPAP Replacement Part Code Schedule
Disposable CPAP Filters A7038 2 per month
Reusable Foam CPAP Filters A7039 1 per 6 months
Standard Non-Heated Tubing A7037 1 per 3 months
Heated CPAP Tubing A4604 1 per 3 months
Replacement Humidifier Chamber A7046 1 per 6 months
Non-Heated Humidifier Unit E0561 1 per 5 Years
Heated Humidifier Unit E0562 1 per 5 Years
CPAP Machine E0601 1 per 5 Years
Bilevel Machine E0470 1 per 5 Years
Bilevel Machine with Backup-Rate Feature E0471 1 per 5 Years

 

 

Non-Covered Items

Most insurance will not cover the following categories of products:

 

- Cleaning Supplies: So Clean CPAP Sanitizer, Mask Wipes, etc.

- Comfort Products: Mask Liners, Creams, etc.

- Power Supplies: CPAP Power Cords and Batteries

- Travel CPAPs: Insurance will not cover a second accessory CPAP for travel.

 

We do not accept insurance for these types of products. However, if you feel your insurance plan may make an exception, you are welcome to file your own claim to be reimbursed by your insurance for your purchase with us. While we can help you with your claim by providing an itemized receipt and billing codes, we cannot guarantee that any reimbursement will be issued by your insurance.

 

Even though these products are not covered by insurance, we understand that they can still be crucial to your CPAP therapy treatment. Contact our customer service team at (866) 564-2252 to check for current promotions and discounts on these products.

 

 

 

 

Using FSA/HSA Spending Cards

If you have a Flexible Spending Account (FSA) or Health Savings Account (HSA) that is linked to a major credit card (such as Visa, MasterCard, American Express), those cards can be used on our website like a regular credit card to purchase medical equipment.

 

We advise that you contact the administrator for your FSA or HSA account, as regulations can vary from plan to plan. While many of these cards will allow you to purchase health-related items that are normally not covered by insurance (such as CPAP cleaning products and power cords), some carriers may not allow these purchases or require an insurance claim to be filed for your order.

 

CareCredit and Health-Financing

We do not accept CareCredit or other health-financing cards. Alternatively, we offer interest-free payment plans for new CPAP machines.

 

 

 

 

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