Working with your physician and your health plan to secure approval for Inspire therapy
There are multiple pathways to insurance coverage for Inspire therapy.
Inspire therapy is being reviewed and approved by insurance providers on a case-by-case basis across the United States. Before the insurance approval process begins, the Inspire trained physician will first deem you are a good candidate for the procedure by confirming you meet the following requirements:
- Diagnosis of moderate to severe Obstructive Sleep Apnea
- Unable to use or get consistent benefit from CPAP
- Not significantly overweight
- Over the age of 22
After confirming you are a good candidate for Inspire therapy, your Inspire therapy physician will work with both you and the reimbursement team at Inspire Medical Systems to gain written insurance approval before your Inspire procedure. This process can take anywhere from a few days to several months.
Watch to learn more about insurance coverage for Inspire.
Commercial Insurance Coverage:
As of January 2018, over 230 private insurance companies have covered Inspire therapy on a case-by-case basis. Because everyone has different insurance plans with different insurance providers, it is difficult to estimate how much you will have to pay out of pocket. Once approved, patients can typically expect to pay the cost of any unmet deductible for the year, along with any required copay or coinsurance fee for a surgery. Staying involved during this process will help with your insurance approval.
Medicare is reimbursing the cost of Inspire therapy based on medical necessity in many geographies across the United States. An Inspire trained physician can discuss Medicare coverage in your area during an initial consultation.
Inspire therapy is on the Federal Supply Schedule, making it available for active military members, veterans, and their beneficiaries at select VA and military hospitals across the US. Click here for more information.