UnitedHealthcare begins denying certain CPAP supplies

Friday, May 3, 2019

This story has been updated.

MINNEAPOLIS, Minn. – UnitedHealthcare’s recent announcement that it would no longer pay for certain CPAP supplies has caught stakeholders off-guard.

Providers in April received letters stating the insurer would not pay for “essential” supplies during the rental period for a CPAP device, says Laura Williard, vice president of payer relations for AAHomecare.

“From a PAP perspective, there’s really no other supplies,” she said. “And the UHC rates for the CPAP units do not come any where close to covering the unit and the supplies, while it’s on rental. The big concern is people are going to quit providing these services.”

Providers have already begun seeing denials for claims as of April 1 and, with an effective date on the letter of Jan. 1, 2019, Williard is concerned UHC may go back and try to recoup those claims.

UHC’s change in policy is a sharp deviation from Medicare guidelines, which allow for supplies to be billed separately. Bundling supplies with CPAP devices is also not realistic, says Williard.

“Sometimes patients need to try multiple masks to find the mask that works for them,” she said.

AAHomecare has sent a letter to UHC outlining its concerns and asking the insurer to reverse the denials and resume payments for supplies. Stakeholders have their fingers crossed that it may be some sort of systems error, and they expect to hear back from the payer this week.

In the meantime, providers should continue to make their concerns heard, says Williard. Providers should use AAHomecare's letter in appealing the denials.

“If they start reaching out themselves to UHC and get enough noise on this, we’ll get some further attention and get them to understand that, while (bundling supplies) may be the case in some scenarios, it should not be the case with CPAP rentals,” said Williard.