Cape Medical Supply : For Patients : Insurance Frequently Asked Questions

These are some of our frequently asked questions related to Insurance.

How do you set up and train your CPAP patients?

We set up our patients with our industry leading Visual Learning Program – a comprehensive suite of training materials administered by certified respiratory technicians. Most of our patients are set up at our full-service Sleep Therapy Centers or on-demand, by appointment only SleepExpress locations in their local community. We also offer at-home setups. Our Compliance Support Team stands ready to support your patients through out their first 90 days on therapy and beyond. For more information, contact your local sales representative.

What kinds of PAP machines do you carry?

We carry CPAP and BiPAP machines built by the nation’s leading manufacturers such as ResMed and Philips Respironics. All of our patients are set up on auto-titrating machines with wireless monitoring capabilities. Our respiratory technicians and Compliance Support Team have the ability to make the necessary adjustments to a patient’s machine remotely. We work with all major insurance providers and do our best to stock their preferred products. For more information, contact your local sales representative.

Where can I find referral documentation?

Up-to-date referral documentation can be found in our convenient online Document Library. Our referral documentation includes instructions and regulations for all insurance providers we are in-network with. All necessary referral documents can be downloaded and faxed or emailed to Cape Medical Supply. We also offer an Online Referral Portal for faster referral processing. If you have referral questions, please call 800-339-3322 and select Option 1.

What is the order status for my patient?

We do our best to process all orders rapidly and accurately. Our distribution team is among the best in the business and all of our delivery vehicles are tracked by GPS. Filling an order can often be held up because of insurance regulations, pre-authorizations and other required steps. We work with our professional partners and patients to educate them on the requirements in order to get an order fulfilled. If you are checking the status of an order, please call 800-339-3322 and select Option 1.

Where can I find relevant Medicare regulations?

Navigating the complex web of Medicare regulations can be confusing for even the most experienced healthcare professional. Our dedicated Medicare and Professional Relations teams have done extensive research on the current Medicare regulations and requirements. You can find them in our Medicare information clearinghouse under the “Medicare” tab on our website. This information is updated regularly. For specific inquiries call 800-339-3322 and select Option 6.

Do you service my region?

Cape Medical Supply provides service across MA, RI, NH and ME. For more information please see our Locations Page, and talk to your local sales representative about how we can partner with you to deliver industry leading care and service to your patients.

What is Sleep Therapy and Why Am I Using It?

Sleep therapy is a treatment used to combat and minimize the effects of obstructive sleep apnea. Obstructive sleep apnea is the involuntary closing of airways causing frequent interruptions during your sleep that can lead to feeling sluggish during the day, high blood pressure and more. Sleep therapy treats this condition by gently circulating air through your respiratory system via positive airway pressure (PAP) in the form of a circulating machine and mask. This treatment will help you sleep, wake up more refreshed and minimize the effects of sleep apnea.

What is a CPAP machine?

A CPAP machine is a piece of equipment that gently circulates air through your nose and throat to combat the effects of sleep apnea. It is hooked up to a small mask that is placed over your nose and sometimes also your mouth, which gently sends air into your nose and throat to keep your tongue from falling back and blocking your airway, which is what happens with sleep apnea. The machine is simple to operate and runs off of a standard electrical outlet.

What is Compliance? How do I meet it?

Compliance is simply using your CPAP machine for an average of 8 hours each night of the week. Your insurance company requires that you meet a minimum level of compliance (usually 75%) within the first 90 days of starting CPAP or else they will no longer cover your machine rental. The only way to get any benefits from CPAP is to use it regularly so you should want to use it! We track your compliance wirelessly via your CPAP machine, and our Compliance Support Team will reach out if we notice you are having any trouble. If you are having difficulty using your machine, please call 800-339-3322 x 4100.

How Do I Care for My CPAP Machine?

You can perform regular maintenance on your CPAP machine at home in a number of ways. You should always have gentle wipes on hand to clean your mask and any part of the machine that touches your face. This will extend the life of the padding and make your machine more comfortable. You should submerge your tubing in warm water and gentle soap every other week to keep it clean of harmful mold and bacteria. You should rinse it with cold water before using it. Only use distilled water in your humidifier reservoir and change it regularly. For more CPAP care tips, check out our blog.

My CPAP Machine is Broken. Can I Fix It?

You can troubleshoot many common CPAP machine issues at home. Many issues are avoidable with regular maintenance and reordering of supplies to keep your mask fitting snugly and to ensure you are always using proper hosing. For tips on how to fix some common issues, please check out our video library. If the issue is with the compressor unit or the machine is damaged, please call us at 800-339-3322 x 4200.

Do I own my CPAP Machine?

No. Your CPAP machine is a rental under most insurances, though many offer rent-to-own plans. You must meet minimum compliance requirements set out by your insurance coverage in order for them to continue to cover your machine rental and resupply services. For more information, call your insurance provider or 800-339-3322 x 4000.

Why am I getting a bill?

You are getting a bill because we are providing a service to you that your insurance company requires that you pay a portion of through a copayment, coinsurance or a deductible. We collect payments for these services from you and your insurance company and make sure everyone is paying and gets paid the proper rate. If you have billing questions, please call 800-339-3322 x 3000.

How can I set up a resupply order?

If you are a CPAP patient, you can set up a profile on our MyResupply service for easy online ordering. Resupply is regulated by insurance, so we can only reach out and remind you to place an order during the periods in which you are eligible for resupply. Once you receive the reminder either via phone, email or postal service, you can set up a resupply order. For CPAP resupply, please call 800-339-3322 x 4300.

What do I need to have ready for my appointment?

The answer varies from therapy to therapy, but generally you will need to bring your insurance card and any documentation from your doctor. For most appointments, we will reach out 24-36 hours before your appointment to provide you with important information and what you need to bring. It is a good idea to check the status of a prior authorization or referral before coming in for your appointment. We recommend scheduling an appointment ahead of time to minimize waiting at any of our locations.

Where can I pay my bill?

We offer several convenient payment options. You can pay via mail with a traditional paper bill, over the phone at 800-339-3322 x 3000 or via our two convenient online options – BillPay and AutoPay. AutoPay allows you to set up automatic payments directly from your bank account so you never have to worry about missing a bill. BillPay is easy to use and lets you pay your bill online when it’s due.

How much will this cost me?

Costs for homecare vary widely from insurance provider to insurance provider and from plan to plan. The best way to get an estimate of your cost is to call your insurance company to find out what they cover and what portion of the cost you are responsible for. We can provide estimates based on our experience but we often don’t know the exact cost until your appointment. If you have any questions, please call 800-339-3322 x 1001.

Do you accept my insurance?

We accept most major insurances including Blue Cross Blue Shield, Tufts Health Plan, UnitedHealthcare. Harvard Pilgrim and many others. The best option for finding out if you can switch to Cape Medical Supply is to call us directly with your insurance plan information so one of our experienced call center operators can assist with your inquiry. For more information, check out the informational posts on our blog.

What is a prior authorization and why do I need it?

Prior authorization is the process by which your provider, in this case Cape Medical Supply, obtains approval from your health insurance carrier prior to receiving a product or service to ensure the carrier will cover the charges for that product or service. Some authorizations can take one day, others can take multiple weeks to be approved. Most therapies cannot be provided without a prior authorization; not having a prior authorization in place is the most frequent delay in receiving care.

What is the difference between a copay and a deductible?

A copayment is a fixed-fee that you pay for healthcare services. The cost is fixed and determined by your insurance company. A deductible is the amount you pay for covered health care services before your insurance plan starts to pay. Once you cover the deductible, insurance kicks in. These payments can be easily confused. Every health plan is different, so check with your insurance company before beginning any therapies as costs vary widely.

My insurance stopped covering my therapy. Now what?

If your insurance stops covering any part of your therapy, please call 800-339-3322 x 3000. Chances are we are already working on resolving the issue, however most disputes must be handled between you and your insurance company.

Why did the price of my care change?

Insurance companies often change pricing and policies abruptly and without warning to vendors like us and patients like you. We have no say in what your insurance will pay for, or how much they will pay for it. We advocate for you at all times but your insurance company sets the rates and rules and we have to follow them and enforce them. We get paid different amounts by different insurances and yes, it confuses us too. We never benefit from denying you equipment, and fight on your behalf with the insurance companies. If you have a dispute with a price change, call your insurance company and fight it. If you have any other questions, you can call us at 800-339-3322 x 3000 or consult this informational blog post.