NOTIFICATION OF ONGOING PAP COVERAGE

Medicare or other health care insurance programs may condition their on-going payment for your PAP only if you continue to use your PAP and if your physician sees you not sooner than 30 days after you begin you PAP therapy. There are certain requirements you and your physician must complete in order for Medicare or other health insurer to continue covering your PAP and supplies after the first  90 days of use. Some of the requirements are:

 

PAP Coverage Requirement
 

For Pap (E0601) and Bi-level (E0470) therapy for treatment of OSA, you must wear the mask with the blower on for a minimum of 4 hours per night on 70% of nights during a consecutive thirty (30) day period anytime during the first three (3) months of initial usage.

 

For Bi-level (E0470 for treatment other than OSA) and Bi-level w/rate (E0471) you must wear the mask with the blower on consistently for a minimum of 4 hours per night, per 24 hour period.

 
 

 You agree to allow the Company to download the usage information via modem and/or to return the data card in the machine to the Company and/or call the Company to read the usage code from the display on your PAP machine.

 
 

 You must have a follow up face to face examination with your treating physician between these dates for PAP and Bi-level due to treatment of OSA:     31st day to 90th day

 

Your physician must document that you are benefiting from your PAP therapy and document that he or she reviewed the usage data of your PAP therapy during the period of time reviewed.

 

For Bi-level (for treatment other than OSA) or Bi-level w/rate, you must have a follow up face to face examination with your treating physician between:   61st day to 90th day

 

If you do not complete all of the applicable requirements your insurance company may not continue to provide reimbursement for your use of your PAP or supplies after 90 days and you may be personally responsible to the cost of renting the PAP and purchasing supplies

The Company will make every reasonable effort to assist you in completing the requirements above. If you have any questions about completing the requirements, contact the Company and ask to speak with one of our PAP Therapy Compliance Coordinators.

By signing this document you acknowledge:

  1. The Company has explained the requirements for continued PAP insurance coverage beyond the first 90 days to your satisfaction, and;
  2. If you do not complete all of the requirements listed here, you agree to either, at your choice, sign an Advance Beneficiary Notice (ABN) and purchase your PAP without insurance coverage or return your rented PAP to the Company at your expense within 90 days of use.

I acknowledge receiving verbal & written instruction regarding my insurance company’s requirements for me to be eligible for PAP therapy coverage after the first 90 days.