Non-Compliant FAQ

Did you receive a letter indicating your 90-Day trial of positive airway pressure therapy has ended and your Insurance will no longer cover therapy?

Below we have organized some frequently asked questions to help you better understand your options.

You have received a letter indicating your Insurance will no longer cover positive airway pressure (PAP) therapy because our records indicate you have not met your Insurance's compliance requirements for continued coverage of equipment and supplies. This letter is to notify you of your options should you choose to continue PAP therapy.

Compliance

Most insurances require a set amount of usage and follow up with your Doctor for continued coverage of PAP therapy and supplies. The most common usage requirements are as follows:

1. 21 days of usage in a 30 day span (usage is 4 hours or more per night)

2. Follow up with your Doctor documenting benefit and usage of PAP therapy (Must be done post 30 days of therapy)

Insurances require compliance for coverage to ensure equipment is being used and benefitted from.

Some Insurances may extend the trial period, allowing you to become compliant. Please contact our Compliance Department if you would like to submit a request to your Insurance for an extension of the trial period.

Please note that Medicare and some Medicare HMOs & Commercial Insurances will not extend the trial period.

Most Insurances require a follow up with your Doctor occur between days 31-90 of therapy. The visit must document use and benefit of therapy.

Some Insurances will accept visits that occur after day 90 of therapy. Please contact our Compliance Department if you have had a follow up appointment with your Doctor.

Compliance requirements are mandated by an Insurance's policy for Positive Airway Pressure therapy. Proof of Compliance is required to be submitted for continued coverage.

Community Surgical Supply at setup and throughout the 90-day trial period provides information about compliance requirements.

Insurance

Insurances rent equipment during the 90-Day trial period. For continued coverage of equipment beyond the trial period, Insurances require proof of compliance be submitted.

Your Insurance's Explanation of Benefits (EOB) will outline all payments for equipment and supplies as well as any amounts deemed your responsibility due to co-insurance and/or deductible.

You can request a copy of the your Explanation of Benefits from your Insurance provider.

Medicare does not allow extensions of the trial period.

Other insurances may approve an extension to the trial period on a case-by-case basis. If you would like to submit for an extension review, please contact our Compliance Department.

Options

Option 1: Return Equipment to Community Surgical Supply

Returning your equipment to Community Surgical Supply will prevent future bills to your account.

Option 2: Purchase Equipment and Supplies

You may choose to keep your equipment and supplies. Non-returned equipment will be billed to you. You may also contact us to arrange payment.

Medicare does not allow extensions of the trial period.

Other insurances may approve an extension to the trial period on a case-by-case basis. If you would like to submit for an extension review, please contact our Compliance Department.

You can pay for your machine and supplies on your own and continue therapy. Please reach out to our Compliance Department to get this set up for you.

You should have received instructions and a shipping label for sending your equipment back to Community Surgical Supply. Please follow the instructions carefully to prevent any issues with your return.

If you need another copy of the instructions and/or shipping label, please contact our Compliance Department.

Misc.

Equipment not returned will be billed to you. You will be responsible for payment of equipment and supplies.

If you believe you received this letter in error, please contact our Compliance Department.