In-Network vs. Out-of-Network CPAP Providers

 In CPAP Insurance

If you are planning on purchasing CPAP supplies using your health insurance, chances are that you will face the option of buying from an in-network vs. out-of-network CPAP provider.  When you are buying from a provider that is in-network with your insurance company, you will almost always have a lower deductible, co-insurance rate, and out-of-pocket maximum a majority of the time.  But, why is this the case?  Let us define these two prospective vendor types in order to make the answer to this question clear.

What do In-Network and Out-of-Network Actually Mean?  (And how does it affect prices for CPAP supplies…)

In-Network – when a CPAP supplier or doctor is “in-network”, it means that they have a pre-negotiated contract with the insurance company such as Aetna or United Healthcare.  The insurance company prefers these pre-negotiated rates because it saves them money, which is exactly why they incentivize patients to go in-network.  They incentivize patients like you to go to an in-network provider by giving patients lower in-network deductibles, co-insurance rates, out-of-pocket maximums, etc. that, as a result, save you money compared to purchasing from an out-of-network provider.  (Tips on How to Find an In-Network CPAP Provider with Your Insurance!)

Out-of-Network – contrary to in-network, out-of-network simply means that there is not a contract between the insurance company and the doctor/ CPAP provider.  Out-of-network CPAP providers cost your insurance company more money than in-network providers because they don’t have pre-negotiated rates with them and as a result, charge your insurance company (and you!) more money.  Consequently, insurance companies do not want you to use out-of-network CPAP providers and that is why your out-of-network deductibles, co-insurance rates, and out-of-pocket maximums are higher than your in-network rates.

CPAP Provider Types

There are three different types of CPAP providers: in-network, out-of-network, and non-insurance (cash-based).  Here is a list to help explain the three types of providers:

  • Insurance-based

    • In-Network – a provider that works with insurance and has a contractual agreement with your insurance company
    • Out-of-Network – a provider that works with insurance but does not have a contractual agreement with your insurance company

  • Non-Insurance (Cash-based) – a cash-based providers does not work with insurance of any kind and only accepts cash, credit cards, and debit cards.  These are also known as out-of-pocket providers

CPAP Purchasing Takeaways

  • Buy In-Network when using your insurance!  An in-network CPAP provider will be cheaper to buy from than an out-of-network provider when using insurance
  • High deductible plan ? Buy from a non-insurance (cash-based) provider.  Cash-based providers have the cheapest prices for CPAP supplies, so if you have a high deductible or are far away from meeting your deductible you’ll save money buying from them.  [Here’s more information on what to do if you have a high deductible plan.]

Health Sqyre has all kinds of CPAP providers on our platform and we do all of the insurance math for you so that you don’t have to.  Easily compare pricing between provider types with the click of the button so you always get the best price!

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