Health Sqyre’s Insurance Overview and FAQs

We are changing the way patients buy CPAP therapy supplies.

Frequently Asked Questions

What health insurance does Health Sqyre accept?

What is the difference between in-network and out-of-network providers?

What are the insurance requirements for reimbursement?

What CPAP products are covered by insurance?

How often can I get CPAP products through insurance?  What is the reimbursement schedule?

What CPAP products are not covered by insurance?

How does health insurance reimbursement work?  How do I get reimbursed by my insurance?

Can I use a Flexible Spending Account (“FSA”) or Health Savings Account (“HSA”) to buy CPAP supplies?

What Insurance does Health Sqyre Accept?

United Healthcare Insurance Form
Blue Cross Blue Shield Insurance Claim Form
Cigna Insurance Form
Kaiser Health Insurance Form
Aetna Health Insurance Form - Health Sqyre
Humana Insurance Form
Molina Healthcare

Health Sqyre works with a whole lot of health insurance companies, big and small!  Health Sqyre works with a large network of CPAP therapy supply providers who are in-network and out-of-network with many different insurance companies.  This allows us to offer every patient the opportunity to buy CPAP supplies using their insurance or not using their insurance and paying out-of-pocket (our tools provide side-by-side price comparison so you can always get the best price and save money!)… all for FREE.

 

Here at Health Sqyre, we understand how complex insurance can be, and we’re here to help; we provide price transparency for each individual patient and insurance services all in real-time.  If you have any questions about your insurance policy or insurance coverage or pricing, simply sign up below for a free account to get instant access to your insurance pricing and insurance coverage dashboard!

What is the difference between in-network and out-of-network providers?

In-network and out-of-network are two major healthcare buzzwords that get thrown around a lot.  While determining what they really mean may seem confusing, it is actually somewhat simple!

 

When a provider is “in-network” with your insurance company, it means that both parties have agreed upon certain terms that are mutually beneficial.  Usually, the provider will have a contract with the insurance company to provide services for a pre-negotiated rate.  Although there are rare exceptions, it is almost always more cost-effective to purchase medical equipment from a provider that is in-network with your insurance plan as opposed to buying from a provider that is out-of network.

 

When a provider is “out-of-network” with your insurance company, it means that the two parties have no contractual obligations to each other.  Therefore, the insurance company will usually offer less or no reimbursement to the provider, so the provider transfers their increased costs onto the patient by increasing the price of the medical equipment sold.

 

Health Sqyre knows which providers are in-network and out-of-network with your insurance company, so you will always know the best price when you shop with us!

Calculating Your Responsibility

Many people going through their insurance worry about getting stuck with the bill after receiving their equipment. Unlike many out-of-network providers, Health Sqyre does not balance-bill patients for the amount that their insurance company denies or does not cover.

 

We do the work up-front to calculate your part of the cost based on your deductible and coinsurance, and you pay your responsibility at checkout. Then we file the claim with your insurance for the remaining cost. Even if things do not work out as planned with your insurance company, we will never send you an additional bill for that order once it is shipped.

 

The only circumstance in which a second invoice will be sent to you is if the insurance company mails the payment check for your order to you instead of to us – which sometimes happens because we are out-of-network. This payment check is the portion of your order cost that your insurance carrier agreed to cover. In this case, we will only invoice you for the amount of the check that you are depositing on our behalf. Alternatively, you can always contact our billing department and mail that check to us instead.

 

You may notice two prices for items on our website. Your responsibility is calculated based on the discounted “Cash” price of your item(s) on our website. “Retail Price” is the price that we will charge your insurance carrier. The Retail Price is the greater of the Medicare Allowable Amount (maximum amount Medicare will pay for a covered health product) or the Manufacturer Suggested Retail Price. This higher amount covers a host of additional expenses associated with billing and collecting from insurance carriers, including, but not limited to, claim submission, documentation gathering, collection efforts, appeals efforts and write-offs of uncollectable claims.

 

If you have any questions about our billing practices, please email support@healthsqyre.com and your inquiry will be forwarded to our billing department.

Insurance Requirements

In order for Health Sqyre to give you real-time insurance pricing, we need:

 

  • Your Name
  • Your Insurance Member ID Number
  • Your Date of Birth

Once Health Sqyre has given you an insurance quote, we will require certain documentation depending on the item being purchased.  This includes, but is not limited to:

 

  • A Prescription
  • Medical Records (e.g. Sleep Test Results)
  • Assignment of Benefits
  • Prior Authorization
  • Compliance
  • Doctor’s Notes

Many payers will follow the Medicare guidelines for patient documentation in order to receive reimbursement.  However, this is not always the case, which leads to the potential for confusion.  No matter who your insurance company is, Health Sqyre will assist you every step of the way to get the documentation required to purchase your CPAP equipment!

Products Covered by Insurance

Not only will most payers insure your CPAP masks and machine, they will also cover many types of CPAP supplies that need to get replaced every few months.  Many private insurance companies follow the same reimbursement schedule as Medicare, which is outlined in the chart below.

Medicare Replacement Schedule

Code Description

CPAP HCPCS

Usual Maximum

Heated Tubing A4604 1 per 3 months
Hybrid Mask A7027 1 per 3 months
Replacement Hybrid Mask Cushion A7028 2 per 1 month
Replacement Hybrid Mask Nasal Pillow A7029 2 per 1 month
Full Face Mask A7030 1 per 3 months
Replacement Full Face Mask Cushion A7031 1 per 1 month
Replacement Nasal Mask Cushion A7032 2 per 1 month
Replacement Nasal Pillow A7033 2 per 1 month
Nasal Pillow Mask A7034 1 per 3 months
Headgear A7035 1 per 6 months
Chinstrap A7036 1 per 6 months
Tubing A7037 1 per 3 months
Disposable Filter A7038 2 per 1 month
Non-disposable Filter A7039 1 per 6 months
Oral Interface Mask A7044 1 per 3 months
Replacement Humidifier Chamber A7046 1 per 6 months
BiPAP Machine E0470 1 per 5 years
BiPAP Auto Machine E0471 1 per 5 years
Non-heated CPAP Humidifier E0561 1 per 5 years
Heated CPAP Humidifier E0562 1 per 5 years
CPAP Machine E0601 1 per 5 years

Products Not Covered by Insurance

Many insurance providers do not cover the following product categories:

  • Cleaning Supplies: So Clean CPAP Sanitizer, Mask Wipes, etc.

 

  • Comfort Products: Mask Liners, Creams, etc.

 

  • Power SuppliesCPAP Power Cords and Batteries

 

  • Travel CPAPs: Insurance will not cover more than one accessory travel CPAP

Insurance Reimbursement

When it comes to buying CPAP equipment, this one of the most important questions.  No matter whether you purchase using cash or insurance, you have the ability file a claim for reimbursement from your insurance company.  When applying for reimbursement, you have two options: have Health Sqyre do it for you (for free!) or apply for reimbursement yourself.

Let Health Sqyre do It

If you shop on Health Sqyre, we will do it automatically for any item that you purchase using your insurance.  We also offer to apply for reimbursement for any product covered by insurance that you purchase using cash as well.

 

To do this, we will request the required insurance documentation and then submit it to the insurance company on your behalf.  We will keep you up to date on your claim status; all you have to do is sit back and let Health Sqyre do the work.  When using Health Sqyre, both of these services are completely free!

Do it Yourself

If you are interested in learning how to apply for insurance reimbursement yourself, check out Health Sqyre’s Guide to Applying for Reimbursement.

Using FSA / HSA Spending Cards

A Flexible Spending Account (FSA) is a special account that allows you to set aside money to pay for certain out-of-pocket medical expenses.  You do not pay taxes on the money sent to this account, resulting in a tax savings advantage.  However, money in an FSA is usually forfeited under the “use it or lose it” rule, if it is not spent at the end of the plan year (this can vary a bit based on your plan).

 

A Health Savings Account (HSA) is very similar an FSA, but the money is not usually lost at the end of the plan year.

 

Regardless of your plan, Health Sqyre accepts it!  To learn more about using one of these accounts, visit our FSA / HSA Help Page!

Please complete the form below if you have any questions and we will answer them as soon as possible.