Northwood’s network of Durable Medical Equipment (DME) providers are partnering with Health New England and your physician to make sure you receive the maximum benefit from your Positive Airway Pressure (PAP) treatment.
To receive the maximum benefit from PAP treatment, you must be compliant with your therapy by using the PAP device for at least 4 hours each night for at least 21 nights during a 30 day period, or as prescribed by your treating physician.
Your PAP machine has been authorized for 3 months. In order to continue coverage for your PAP device beyond 3 months, you need to:
1. Document Your Compliance with the PAP Treatment
Your PAP device is equipped with a read-out function and removable memory card that records your usage of the device. Your DME provider will educate you on how to provide this information by either bringing the memory card to the DME provider or how to use an online software application to verify the compliance information.
2. See Your Treating Physician
A face-to-face evaluation by your treating physician is required between the 31st and 91st day after receiving the PAP device. Your physician will need to document that your symptoms have improved.
If you're compliant with PAP treatment and your physician documents the effectiveness of PAP treatment for your symptoms, your benefit coverage for PAP treatment will continue.
If you are found to be non-compliant with your PAP treatment, it has not improved your symptoms or the PAP device is no longer prescribed by your physician, your benefit coverage for this device and related accessories, will not continue. If that happens, you will be notified and you must return the device to the DME provider or you will be responsible for any balance.
Member Acknowledgement:
By submitting this form, you are agreeing to the terms below.
1. Medical Information Authorization: Customer authorizes any holder of medical information relating to said Customer to release to Reliable Respiratory any record pertaining to his or her medical history, services rendered, or treatment. Customer authorizes Reliable Respiratory to release Customer’s medical information to appropriate accreditation and insurance company personnel and other health care related organizations. Customer authorizes use of email to communicate with these organizations.
2. Financial Responsibility and PAP Treatment Compliance: Customer understands that insurance coverage is not guaranteed and remains responsible for all amounts not paid by insurance, including denied claims, copayments, deductibles, coinsurance, and other non-covered charges. Customer authorizes Reliable Respiratory to charge the credit card on file for such amounts. Any balance that remains unpaid more than fourteen (14) days after the due date may be subject to collection efforts, and Reliable Respiratory may require the return of equipment until the account is paid in full.
Customer also acknowledges having read and understood their responsibilities to follow the above treatment compliance terms associated with their PAP device. Customer understands that if ongoing PAP benefit coverage is not approved and the device is not returned to Reliable Respiratory, Customer will be financially responsible for any applicable costs associated with the device.
3. Communications Consent: Customer authorizes Reliable Respiratory and its service providers to contact Customer by non-automated, automated, or AI-assisted calls, text messages, emails, and other digital communication channels regarding care, therapy, resupply, scheduling, billing, payment, and provider coordination. Calls may be recorded. Consent to receive such communications is not a condition of receiving care or services. Message and data rates may apply. Customer may opt out of marketing or non-essential communications at any time by replying STOP, using an unsubscribe option, or contacting Reliable Respiratory.
4. Assignment of Insurance Benefits: Customer authorizes any and all Medicare, Medicaid, or other insurance benefits to be paid directly to Reliable Respiratory for any equipment or services furnished to Customer by Reliable Respiratory.