Tips from Paula: CPAP Machine Authorizations

With increased technological advances in the diagnosis of sleep apnea, more and more patients are being told by their physicians that they could be candidates for a CPAP (Continuous Positive Airway Pressure) machine.  It is important for patients to know what is expected from the doctor when this machine is recommended.

First, the doctor’s office will need to call the insurance company to obtain authorization for a sleep study.  Many insurance carriers contract this authorization process out to a third party.

Once the sleep study is approved and completed, the doctor may now recommend a CPAP machine.  As with the sleep study, this device will need to be approved by either the insurance company, or the third party review company.

We strongly urge our customers to contact their insurance carrier to see if the authorization has been done before obtaining any sleep study services or medical equipment.   Failure to obtain authorization could result in  substantial costs for the patient, as well as denial for equipment.  For example, a lack of authorization for sleep study could mean an automatic denial for a CPAP machine.   The authorization for the sleep study and the CPAP machine itself are a two-part process.

We advise patients to never assume that their physician has gone through the different phases of authorization required. It is always best to “pick up the phone” and call the number on your health plan ID card to be sure your authorizations are in place for any sleep studies or related equipment.  If the patient makes that call and finds out the authorizations are not in place, the next step is to have the patient call their doctor’s office to remind them of their responsibility to obtain the patient’s proper authorizations and to follow up as needed.

Please contact me directly with any questions and I am happy to help.

Paula Green