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 determine whether you are a good candidate for the procedure by confirming whether 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
- Pass a general health assessment & airway anatomy exam
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.
https://player.vimeo.com/video/136672811 Watch to learn more about insurance coverage for Inspire.
Commercial Insurance Coverage:
Inspire therapy is being reviewed and approved by insurance providers on a case by case basis. As of December 2018, over 320 insurance providers have covered the cost of the procedure. If the Inspire trained doctor believes Inspire is right for you, he or she will work with you and the insurance team at Inspire Medical Systems to submit your case to your insurance provider for coverage. 75% of people who submit for insurance coverage get it and the procedure is not scheduled until it has been approved. If 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.