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Patient Resources

We’re here to help

Getting the equipment you need to stay healthy can be intimidating when it comes to health insurance, terminology and paperwork. You may be wondering “Does my health insurance cover CPAP?” At Fort Myers Oxygen, our team is dedicated to help every single patient overcome the red tape and get back to living healthy.  We treat our patients as if they were our own family members.  We’ve been around so long because word of mouth is our best marketing and we strive everyday to earn our amazing reputation.

This page is meant to be a resource to you. However, you can pick up the phone and talk to someone anytime for your specific questions.  It’s our goal to make getting your medical equipment as speedy and easy as possible.

Our staff has years of experience dealing with insurance carriers and healthcare professionals. Let us help you navigate the process without hassle so you can get back to your life.  Your best life is our mission.

Medicare

Medicare

The Different Benefits of Traditional Medicare

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Medicare Part A benefits cover hospital stays, home health care and hospice services.

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Medicare Part B benefits cover physician visits, laboratory tests, ambulance services and home medical equipment.

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While oftentimes you do not have to pay a monthly fee to have Part A benefits (you only have to pay money when you use the services), the Part B program requires a monthly premium to stay enrolled (even if you do not use the services). In 2017 that premium was $134 per month (but could be less) depending on your income. Typically, this amount will be taken from your Social Security check.

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Medicare Part D offers optional program benefits that cover prescription drugs.

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For more information about your benefits or making coverage decisions, you can visit the official website for Medicare benefits at www.medicare.gov.

What’s Covered Under Medicare For CPAP Therapy?

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Sleep Studies

Medicare Part B (Medical Insurance) covers Type I, II, III, and IV sleep tests and devices if you have clinical signs and symptoms of sleep apnea.

Your costs in Original Medicare
You pay 20% of the Medicare-approved amount after you’ve met your Part B deductible.
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CPAP Equipment

Medicare Part B (Medical Insurance) covers the cost of medically necessary durable medical equipment (DME) if your doctor prescribes it for use in your home. Medicare DME coverage includes, but isn’t limited to:

 

If your supplier accepts assignment you pay 20% of the Medicare-approved amount, and the Part B deductible applies.

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Oxygen equipment & accessories

Medicare Part B (Medical Insurance) covers the rental of oxygen equipment and accessories as durable medical equipment (DME) that your doctor prescribes for use in your home when all of these conditions are met:

  • Your doctor says you have a severe lung disease or you’re not getting enough oxygen and are in a chronic stable state.
  • Your health might improve with oxygen therapy.
  • Your blood oxygen level falls within a certain range.
  • Other alternative measures have failed.

If you meet the conditions above, Medicare helps pay for:

  • Systems that provide oxygen
  • Tubing and related supplies for the delivery of oxygen and oxygen contents

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Your Health Care Professionals

You have the right to choose your CPAP equipment provider, just ask for us!

Your Doctor’s Checklist For Insurance

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WRITTEN ORDER PRIOR TO DELIVERY (WOPD) INCLUDES

  • Order Date
  • Patient Name
  • Detailed Description of items ordered
  • Practitioner NPI
  • Practitioner Signature
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DIAGNOSTIC SLEEP STUDY

Within 12 Months of order date

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FACE-TO-FACE WITHIN 6 MONTHS PRIOR TO THE WOPD DATE

If face-to-face prior to diagnostic study is within 6 months of WOPD date, then no new face-to-face is needed. 

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IF BIPAP (E0470) ORDERED, NEED CPAP/BIPAP TITRATION STUDY

Shows CPAP pressures insufficient and BIPAP pressures required. 

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PATIENT HAS FOLLOW-UP VISIT SCHEDULED

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FYI

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COMPLIANCE

Most compliance periods last for 90 days. To be considered compliant a patient must use their sleep therapy device for more than 4 hours a day and 70% of a 30 day period..

  • This equates to a minimum of 21 out of 30 days. To be counted a machine must be used a minimum of four hours per day.
  • A patient who uses their machine for 3 hours per day 21 days in a 30 day period is considered 0% compliant.
  • A patient who uses their machine 4+ hours per day  for 21 days in a 30 day period is considered 70% compliant.
  • The four hour minimum is counted cumulatively, not consecutively – patients who sleep with their machine for one hour in the afternoon then three hours at night meet their four hour requirement for that day.
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AN FYI: WHAT IS LCD?

A local coverage determination (LCD) is a decision made by a Medicare Administrative Contractor (MAC) on whether a particular service or item is reasonable and necessary, and therefore covered by Medicare within the specific region that the MAC oversees. Learn more here

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CareCredit

CareCredit helps you pay for out-of-pocket healthcare expenses for you, your family, and even your pets! Once you are approved, you can use it again and again* to help manage health, wellness and beauty costs not covered by insurance.

Medical Websites and Other Resources

Medical Websites and Other Resources

Find resources and information on a wide variety of health conditions.   The Internet is a great source of information for you to use in managing your healthcare or the healthcare of a loved one. It can also be a good way to locate the support resources you need...

Join A Support Group

Join A Support Group

You are not alone with Sleep Apnea.   Sleep Apnea Living Your Life The AWAKE support group program  Q: What is A.W.A.K.E.? The ASAA organizes a network of support groups known as A.W.A.K.E. (Alert, Well, And Keeping Energetic), composed of hundreds of mutual-help...