29/09/2025
How to Claim a CPAP Machine from Medical Aid
A CPAP (Continuous Positive Airway Pressure) machine is considered durable medical equipment, and most medical aid schemes will cover it if you meet certain requirements.
General Requirements:
• Medical necessity: You need a confirmed diagnosis of obstructive sleep apnea (usually from a sleep study).
• Prescription & documentation: Your doctor must provide a prescription, your diagnosis (ICD-10 code), and proof of medical necessity.
• Purchase or rental: Some schemes only cover new CPAP machines or may prefer rentals over purchases.
• Approved provider: You may need to buy from a supplier approved by your medical aid scheme.
Claim Procedures & Funding
• Pre-authorization: Many schemes require approval before purchase.
• Benefit limits: Costs may be paid from your savings account or external medical items benefit.
• Waiting periods: If you’re new to a scheme, a waiting period may apply.
• Frequency limits: For example, Discovery covers one CPAP machine every 3 years.
How to File a Claim
• Get a prescription: From your doctor or specialist, with your ICD-10 diagnosis code.
• Request a quote: From an approved provider (must include diagnosis, NAPPI code, itemized pricing).
• Submit the claim: Online via your medical aid portal, by post, or directly through your supplier (many submit on your behalf).
• Confirm eligibility: Check your scheme’s rules on limits, waiting periods, and coverage.
Contact us:
admin@cpap2breathe.co.za
+27 (0) 72 874 0844
www.cpap2breathe.co.za
*We deliver nationwide:
– Nelspruit
– Secunda
- Tzaneen
- Hoedspruit
– Cape Town
– Potchefstroom
– Ermelo
– Worcester
– Cradock
– Middelburg