Frequently Asked Questions

We want to make your experience with us convenient and enjoyable. Please call our office if you have any questions or concerns about the medical equipment prescribed to treat your sleep apnea.

1. What if I haven't used my machine in a while?

No problem. Just come in and we’ll re-educate at no additional charge!

2. Will my insurance cover my CPAP/BiPAP machine?

Most insurance companies will pay for a substantial portion of the allowed amount for a CPAP/BiPAP machine.* Insurances require that certain criteria are met to qualify for a machine initially, such as a sleep study at a certified sleep center and a documented diagnosis of Obstructive Sleep Apnea. The physician will provide this documentation and the prescription. Capital Medical Systems, LLC will obtain these records from your doctor to ensure that all requirements for your particular insurance carrier have been met, prior to your initial set-up.

3. What is my out of pocket expense or OOP?

In the state of Alabama, Blue Cross and Blue Shield of Alabama’s average coverage for sleep therapy equipment is 80% of what they allow. The remaining 20% is due from the patient or a secondary carrier. The deductible due each year will be taken separately. Every policy must be treated individually since the benefits are based on each person’s employer’s plan.

4. When can I get a new CPAP machine?

Most insurance policies will cover a new machine every 3-5 years, depending on the condition of the patient’s current machine and if the patient’s medical history indicates continuous use with a prior machine. Medicare has a 5 year minimum and all other insurance carriers vary from 3-5 years.

5. Will my insurance pay for a new mask, tubing, filters, etc? (aka CPAP Supplies)

There is a 10-month introductory period that has to be fulfilled, prior to any supply purchases, following the initial set-up on a CPAP/BiPAP machine. A current prescription must be on file with the supplier in order to file any services to your insurance carrier. A prescription will expire after 12 months. Medicare allows supplies to be purchased from 1 to 6 months, depending on the supply. All other carriers usually will only cover supply purchases every 6 months, following the 10 month introductory period.

*This is not a guarantee of payment from your insurance carrier.