Why Do Patients Choose to Pay Out-of-Pocket for Medical Devices?

1.No health insurance but still need to treat sleep apnea.

Without health insurance, patients with sleep apnea have no choice but to pay out of pocket for machines and supplies.

2.High deductible health insurance plans.

Many American now have a higher deductible before health insurance benefits kick in. Almost all plans require meeting your entire individual or family deductible before CPAP supplies or sleep studies are partially covered. If you don’t meet the deductible, you will have to pay insurance prices which are typically much higher than online retail stores.

3.Dealing with health insurance is too complicated and intrusive.

Dealing with insurance means authorizations, co-insurance, explanation of benefits, and dealing with poor customer service. Since CPAP equipment is rented, patients must provide personal data to prove compliance or risk losing their equipment.

4.Limited options and support.

Working through insurance means you are only authorized to work with certain providers for CPAP supplies. This generally means limited product choice, poor customer service and limited, if any, care support.

5.Costly follow-up.

To stay within the insurance guidelines, patients have to schedule repeat physician visits or, at minimum, have their personal therapy information sent to the equipment provider to verify use and compliance. This might involve additional costly physician visits and time away from work.

Insurance Claim vs Paying Out-of-Pocket

Using health insurance to pay for medical expenses and equipment has been the traditional path. However, with rising costs, patients are researching and becoming knowledgeable on alternatives. After some simple comparisons, the option of paying out-of-pocket can be both convenient and cost-effective in the long run. Here’s a breakdown of the insurance vs cash pay pathway.

  • Health insurance providers contract with specific DME providers. Patients can only work with these approved DMEs, regardless of equipment choice, location or level of customer service. Alternatively, by researching online, a patient can choose their provider by whatever measure they prefer: price, selection, customer review, or location.
  • DMEs have a limited selection of CPAP mask and machines. As a result, patients may not have access to the newest, most effective, or preferred options.
    Our hand-picked inventory includes 50 masks, 20 machines, and countless comfort and cleaning accessories, ready to ship the same day.
  • With insurance, patients are required to rent the PAP machine and cannot outright purchase their equipment. In many cases, the total amount patients owe over the length of the rental is higher than the machine’s original cost. The total cost is provided upfront and often times lower due to financing options, frequent sales and promotions.
  • Insurance does not cover the full cost of your PAP machine. Only after all deductibles are met, insurance typically covers only a percentage of the total cost. The balance is owed in monthly installments. When payment overlaps into the next year, a patient’s deductible resets. A simple transaction via credit, HAS, or through financing and the machine is yours.
  • Somewhat intrusively, insurance requires compliance during the rental period or you can risk losing the machine. Use of a CPAP for 4 hours per night for 21 out of every 30 nights is considered compliant. Access to personal data is necessary to determine compliance. When owned, permission must be granted for access to a patient’s data. There is also no risk of losing the machine due to non-compliance.
  • DMEs are often criticized for poor customer service and limited support. Patients are forced to turn to their busy physicians for answers to simple questions. Our customer care team can recommend products and troubleshoot concerns. Connecting patients with sleep coaches to initiate therapy increases compliance and provides a more satisfied user experience.
  • If paying through insurance, patients are not allowed to upgrade their PAP machine for at least 5 years and not approved to purchase a second travel unit. With cash pay, patients can buy any equipment they want when they want it. And with competitive pricing and frequent sales, the cost is a fraction of what they would pay through insurance.