New Hire Onboarding  •  Lesson 3 of 6
Insurance &
Eligibility
Our biggest competitive advantage. You need to understand it to use it.
What You'll Learn
She Pays Nothing. We Handle Everything.
That's the power of insurance coverage — and why understanding it makes you unstoppable on the phone.
Why Insurance Changes Everything
No other online CPAP company works with insurance the way Easy Breathe does. That's our competitive advantage — and it's why customers choose us.
~90%
of our customers have insurance coverage for CPAP supplies.
When you check eligibility and the customer is covered, the conversation changes completely. Price stops being the obstacle.
What is DME?
Durable Medical Equipment — that's the insurance category we bill under.
DME includes equipment prescribed by a doctor for use at home — wheelchairs, nebulizers, oxygen, and yes, CPAP machines and supplies. Medicare and most private insurance plans have a DME benefit that specifically covers these items.
CPAP qualifies as DME
Machines, masks, and all replacement supplies are covered under DME benefits.
Doctor's order required
A valid prescription is needed to bill insurance. We help customers get it.
We bill directly
We are a DME provider. We submit the claim — the customer doesn't have to.
Major Insurance Carriers
Aetna
Large national carrier. Widely accepted. Good DME coverage.
UnitedHealthcare
One of the largest. Coverage varies by plan — always verify.
Humana
Strong Medicare Advantage presence. Frequent with CPAP customers.
BCBS
Blue Cross Blue Shield. Regional plans vary — check the specific plan.
Cigna
Strong employer plan coverage. Good benefits for CPAP supplies.
Medicare
Part B covers DME. 80% paid after deductible. Strict documentation rules.
There are many more. We verify each one — the system tells us what's covered.
Eligibility Verification
Before we process any insurance order, we verify that the customer's plan actually covers what we're ordering.
What eligibility verification tells us:
  • Is the customer's insurance active?
  • Is CPAP equipment covered under their plan?
  • What's their deductible — and how much has been met?
  • What's the copay or coinsurance percentage?
  • Are they in the 90-day reorder window?
You don't do this manually — the system handles it. But you need to understand what the results mean.
Deductibles & Copays — Simply
Deductible
The amount the patient pays out of pocket before insurance starts covering. Once met, insurance kicks in for the rest of the year.
Example: $500 deductible, $200 met → $300 still owed before insurance covers anything.
Copay / Coinsurance
After the deductible is met, the customer pays a percentage. Medicare pays 80%, patient pays 20%. Many private plans are similar.
Best case: deductible fully met, plan pays 100% → customer owes nothing.
#1 Conversion Trigger — Say This
"There's no cost
to you."
When the deductible is met and the plan pays in full — say it clearly and confidently. This phrase is the biggest driver of conversions in the business.
Insurance vs. Cash Orders
✓ Insurance Order
We verify eligibility before ordering
We submit the claim to insurance
Customer pays $0 to little out of pocket
Valid prescription required
90-day reorder cycle — recurring revenue
More operational work, but higher value
💳 Cash Order
No insurance check needed
Customer pays retail price
Faster to process — no claims
Prescription still preferred (not always required)
Travel CPAPs (AirMini) = always cash
Lower average order value
Prescriptions
Insurance requires a valid prescription before we ship. No prescription = no insurance order.
Customer has their prescription — great. We'll collect it during the order process.
Customer doesn't have it — we can request it from their doctor directly. We do this routinely.
Existing customer reordering — we often already have the prescription on file. Smooth.
Don't lose a sale over a prescription. We can help get it — just don't promise delivery timelines.
Insurance Covers the Machine and the Supplies
The AirSense 11, replacement masks, filters, tubing — all DME. All billable. All part of what you're helping customers access.
90
days — the standard insurance reorder window for CPAP supplies.
After 90 days, the customer is eligible for a fresh set of supplies. We track this date for every customer and reach out when the window opens. This is the engine of our recurring business.
Delivered to Their Door
Once the insurance order is verified and approved, we ship directly. The customer doesn't go to a store. They don't wait on hold with their insurance company. We handle it.
Common Scenarios on a Call
"My deductible is met" — Best case
Insurance pays in full. Say "there's no cost to you" and close the order.
"I have a copay" — Common case
Quote the exact amount from eligibility. Often $20–$50. Still a great deal vs. full retail price.
"I haven't met my deductible" — Harder case
Be honest. Offer cash pricing as an alternative. The supplies are still far cheaper than retail.
"I don't have insurance" — Cash customer
Offer cash pricing. We're still competitive. Process as a standard cash order.
Things to Never Say
✕ Don't say "I think you're covered"
Always verify before making coverage promises. Say "let me check your benefits."
✕ Don't guarantee delivery timing
Insurance orders require verification. Timelines depend on claim approval and shipping.
✕ Don't discuss claim specifics you're unsure of
If a customer asks a detailed billing question — escalate to the billing team. Don't guess.
✕ Don't say "Medicare won't cover that"
Medicare covers a lot — but there are rules. Always verify. The system knows.
When It Works, It Really Works
The customer pays nothing, gets their supplies, and we bill insurance. They tell their spouse. They become a loyal reorder customer for years. That's the flywheel in action.
Every Supply Is an Insurance-Covered Touchpoint
Humidifier chambers, heated tubing, filters — each one is a reason to call, a chance to reorder, and revenue for Easy Breathe. Insurance makes it effortless for the customer.
Insurance Quick Reference
Lesson 3 — Complete.
  • DME benefits and how insurance covers CPAP
  • Major carriers — Aetna, UHC, Humana, BCBS, Cigna, Medicare
  • Eligibility, deductibles, copays — the basics
  • The 90-day reorder window
Up next → Lesson 4 of 6: The Phone Call
← → to navigate  •  click to advance