SLEEP DISORDERS
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Sleep disorders can impact one’s health, mood and energy levels. Recommended treatments for sleep disorders are Continuous Positive Airway Pressure (CPAP), as well as Bi-level devices, which provide airflow at prescribed pressures during sleep and help maintain open airways in patients suffering from obstructive and central sleep apnea.
Most patients utilizing CPAP report better quality sleep, more energy, increased alertness, and improved cognitive function. Understandably, for treatments to be effective, patients must comply with their prescription. Transcend Medical professionally-trained staff helps patients maximize compliance through careful instruction and follow-up monitoring.
My Doctors Says I need CPAP/BiPAP - What Next ?
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Your physician will send your information, including the necessary documents, to Transcend Medical so your account can be created.
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Within 24 hours of receiving this information, you will receive an call confirming receipt of your order.
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Transcend Medical will verify your insurance and notify you if any additional documents are needed and will work to obtain that information from your physician.
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Once all documents are approved, we will schedule your appointment to set up and train you on your equipment according to your physician’s orders.
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Our dedicated team is committed to help you succeed with your PAP therapy, especially within that first critical 90-day period.
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Our Sleep coach will contact you 3 times the first week to answer any questions you have about your new therapy, then 2 times the next week, and on week 3 & 4 we will contact once. (Then only as needed)
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Our representative will follow up with a call/email/text to make sure you receive the necessary supplies each time you become eligible for a new supply’s. Typically, every 90 days, subject to compliance adherence.
WHAT IS PAP THERAPY?
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You have been prescribed a therapy that uses PAP (Positive Airway Pressure) technology to manage your sleep apnea symptoms. This therapy includes a mask interface and a PAP device that streams air into your airway while you sleep. This stream of air keeps your airway open and allows you to breathe more naturally, and sleep with less arousals in the night.
Depending on your diagnosis, you will either be prescribed a CPAP or a Bi-Level Machine:
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CPAP (Continuous Positive Airway Pressure) has one constant stream of air administered.
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Bi-Level, also called Bi-PAP, uses two different pressures, one higher when you inhale, followed by a lower pressure to allow for an easier exhale.
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CPAP & MASK REPLACEMENT
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Proper maintenance will prolong the use of your CPAP equipment and mask, but over time your equipment will need to be replaced. Here are some signs that your equipment is overdue for replacement:
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Tubing is discolored, stretched or unable to fit onto the CPAP.
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Mask seals are discolored, not sealing as well as when new or show signs of tearing.
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Headgear is over-stretched or discolored.
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CPAP chamber shows evidence of deterioration including residue buildup on the heater-base, signs of cracking, or small water leaks.
Many insurance providers recognize the need for CPAP equipment and mask replacements and may cover the cost of some of these. A typical replacement schedule of your equipment is shown below:
Replacement Schedules*
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Product Replacement
A) Disposable Filter A) 2 Per Month Sent in 3 Month supply
B) Reusable Filter B) 1 every 6 months
Nasal Pillows/Cushions Twice per month. Sent in 3 month supply
Full Face Seal Monthly
Tubing 3 Month
Mask 3-6 Months
Chamber 6 Months
Headgear 6 Months
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MEDICARE PAP GUIDELINES - COMPLIANCE REQUIREMENTS
Medicare and most insurance plans require that compliance is met on your behalf. Please see the information listed below regarding compliance requirements.
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What is compliance?
Beneficiary to use PAP device minimum of 4 hours or more, 30 days consecutively, within the first 90 days, 70% or greater. We recommend you use the device the whole time your sleeping, not just the minimum.
Follow up with your physician 30 days after your start therapy and discuss therapy outcomes. Your physician must indicate you benefit from PAP therapy, so your insurance can continue payment.
What happens if I am not compliant?
If you are not compliant 70% or greater within the first 90 days you have the following options
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If you like to continue therapy and have your insurance payer consider payment of the device, then you will need to schedule the following:
- Physician appointment explaining what the barriers/ issues were and why you couldn’t use the PAP device as directed
- Schedule an In-Lab sleep study (not home) test
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If you do not want to continue therapy then you can schedule the following:
- Contact Transcend Medical to schedule return of PAP device
- Return the PAP device at any local Transcend Medical Retail Location
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If you want to continue therapy, keep the PAP device, and not have another study
- Contact Transcend Medical to provide the form to be completed for this option and arrange final payment(s) of device
- Please note, any replacement supplies will not be covered by your insurance payer since compliance was not met and will be an out of pocket expense.
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Are there any exceptions to the compliance rules?
Most insurance payers only allow one exception to compliance requirements. If the beneficiary has been admitted to inpatient status (hospital admission, skilled nursing home, rehab center, etc.). The compliance timeframe will be extended for the time while inpatient status. Medical records/ documentation will be required to prove the inpatient status.
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Who do I contact if I have problems with my PAP therapy?
You can call 1-800-644-3324 or your physician’s office /sleep lab.
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