Welcome To Prism Health Care Services Sleep Therapy Program

Our team of licensed Respiratory Therapists, customer service and scheduling team are committed to working with you to improve your sleep.  Click on the review badge (the blue circle to the right) to hear what our customers are saying about their experience. We have designed the content of this page to assist you in preparing for your upcoming appointment and the first 90 days of therapy.  Please take a moment to read and write down any questions you may have to discuss with the Respiratory Therapist during your therapy education appointment.

Before Your Appointment

1. Ask your sleeping companion to attend your device education appointment with the Respiratory Therapist. Having a good support person to understand your condition and prescribed therapy is important for continued success.
2. Download and review the Sleep Therapy Equipment Overview. For your convenience, the Sleep Therapy Equipment Overview is included in the Additional Resources section of this page. The Respiratory Therapist will be going over this information during your visit.
3. Write down questions to ask the Respiratory Therapist during your scheduled visit time.
4. Over 94% of our customers become compliant with therapy within the first thirty days by using the myAir^TM.  If you have a smartphone, we recommend you download the myAir^TM app from the Apple App Store^® or Google Play^TM.  Complete steps 1-3 prior to your scheduled appointment.   The Respiratory Therapist will assist you in completing step number 4 during your scheduled visit time.  The coaching section of the app is a great resource for common questions and concerns that may come up as you begin your therapy. 
5. If you do not have a smart phone, you can register on line at myAir.Resmed.com
6. Your CPAP or Bi-Level device will come with an integrated humidifier to provide comfort and prevent dryness while you sleep. We recommend you purchase a gallon of distilled water for the humidifier.  The distilled water will help prevent calcification and mineral deposit build up in the humidifier chamber, which can cause the humidifier to not function properly.  If you do not have access to distilled water at this time due to COVID-19, tutorials such as this one can be found online to help you make your own distilled water at home.  
7. Insurance Reimbursement: The CPAP or Bi-Level device that you will receive is a rental.  The device will rent each month based on the anniversary date of your scheduled set-up date with the Respiratory Therapist. 
8. Be prepared to pay any applicable co-insurance or deductible during your scheduled appointment. Contingent upon your individual insurance plan benefit, you may receive a monthly co-insurance bill for the device.  On average, you can expect the device will rent for 10-13 months before the device is purchased by your insurance company.  
9. CPAP and Bi-Level Device Mask Options: Prior to your appointment, we recommend that you become acquainted with the various mask options.

There are four types of masks for CPAP or Bi-Level Therapy:

• Nasal CPAP Mask: This mask covers the nose. 
• Nasal Cushion Mask: This mask is a cushion that fits under the nose with minimal face contact.
• Nasal Pillows CPAP Mask: This mask has minimal facial contact, no forehead support and fits right under the nasal cavity making the mask very light and comfortable.
• Full Face Mask: This mask covers both the nose and mouth.  They are typically used by people who breathe through their mouth but do not want a combination of a nasal mask with chinstrap. 

For more detailed information on mask options click on this link.  https://www.resmed.com/epn/en/consumer/products/masks.html

What to Expect During Your Appointment

1. The Respiratory Therapist will:
   1. Review the information provided in the Sleep Therapy Equipment Overview, also found in the Additional Resources section of this page.
   2. Provide detailed instruction on how to use your sleep therapy device, supply replenishment process and routine infection control/cleaning information.
   3. Complete a mask fitting to ensure a snug and comfortable fit while you sleep.
   4. Collect payment for applicable co-insurance and or unmet deductible.
2. At the end of the appointment, the Respiratory Therapist will ask you to complete a return demonstration to ensure that you are able to independently operate your medical device.

What to Tell Your Respiratory Therapist

1. Let your Respiratory Therapist know if you have downloaded the myAir^TM application and completed steps 1-3. The Respiratory Therapist will assist you in completing Step 4, adding your device.
2. Communicate any concerns with claustrophobia, mask options and or other therapy concerns. We are here to help make the transition to compliant sleep therapy worry-free.

What To Expect The First Week of CPAP or Bi-Level Therapy 

1. Being on CPAP or Bi-Level therapy requires a change in behavior and commitment. People adjust to situations in different ways and at their own pace.  The key is to use the device every night. 
2. Consistency in using the CPAP or Bi-Level therapy is critical to improving your health and associated symptoms.
3. Try using the CPAP or Bi-Level therapy while watching TV or while reading a book to start adjusting to the mask.
4. Some new CPAP or Bi-Level therapy users wake up rested after the first few nights of use, however others may take more time for the body to adjust to this new way of sleeping. Occasionally, you may notice vivid dreams while getting used to the therapy.
5. Use the myAir^TM to track your daily progress with therapy. This app will assist you in identifying how long you are using the CPAP or Bi-Level therapy each night.  The coaching section of the app is a great resource for common questions and concerns that may come up during your therapy.

CPAP and Bi-Level Device Disposable Supply Fulfillment: The First 3 Months of Therapy

1. Contact our office at 847-310-4730, Monday -Friday 8:30 a.m. – 5:00 p.m. to order your supplies.
2. Your insurance company will cover the cost to replace your disposable supplies in accordance with the supply fulfillment schedule in this section. Please note that, based on your individual insurance benefits, you may be financially responsible for unmet deductible and co-insurance.
3. Plan ahead. Some insurance carriers require prior authorization or additional information prior to supply delivery. Delivery of supplies may take up to five business days. 
4. For your convenience, all replenishment supplies will be mailed directly to your home address.
5. Upon achieving the insurance required therapy compliance period, our team will enroll you in the PAP supply replenishment call or email program. Please refer to the Therapy Continued Coverage Beyond The First 90 Days for additional information.   

PAP Supply Insurance Reimbursement Fulfillment Schedule

Monthly:

• Nasal Cushion/Pillow: 2 Per Month
• Disposable Filters: 2 Per Month
• Full Face Mask Cushions: 1 Per Month

Every Three Months:

• Mask Frame (excludes headgear): 1 Every 3 Months
• Tubing (standard or heated): 1 every 3 Months

CUSTOMER RESPONSIBILITY:

Insurance Guidelines for CPAP or Bi-Level Therapy For The First 3 Months and the 90 Day Compliance Period

Based on your prescribed therapy, CPAP or Bi-Level, schedule a follow up face to face appointment with your treating physician. Refer to Continued Equipment Coverage Beyond 90 Days for more information regarding the importance of this appointment.

• Schedule a face to face appointment with your prescribing physician.
• Refer to the device information in this section for information on the timing of that appointment. 
  • CPAP Therapy: The appointment should be no sooner than 31 days and no greater than 91 days after initiating therapy. 
  • Bi-Level Therapy: The appointment should be no sooner than 61 days and no greater than 91 days after initiating therapy.

For continued financial coverage, your medical insurance carrier requires completion of key steps during your first 90 days of therapy.  The key steps outlined in this section are important to complete, otherwise the insurance will stop paying for the device and related supplies after the 90-day period is complete. Please refer to either the CPAP or Bi-Level Continued Coverage Beyond the First 90 Days of therapy for guidance.

CPAP Continued Coverage Beyond the First 90 Days of Therapy

	Step 1: Schedule a face-to face office visit with your doctor no sooner than the 31st day but no later than the 91st day after starting CPAP therapy.
	Step 2: During your appointment your doctor will review and document the actual CPAP usage and determine if you are benefitting from the therapy
	Step 3: Prism Health Care Services will contact your doctor to obtain the medical office visit notes.
	Step 4: Your medical insurance plan will continue to pay for the CPAP device upon receiving the medical record notes showing evidence of: 1. CPAP device usage 21 out of 30 days over a consecutive 30 day period. 2. CPAP device usage averaging 4 hours per night during the consecutive 30 day period. 3. Doctor medical record note confirming your health is benefitting from the use of CPAP therapy.

BiPAP Continued Coverage Beyond the First 90 Days of Therapy

	Step 1: Schedule a face-to face office visit with your doctor no sooner than the 61st day after starting BiPAP therapy.
	Step 2: During your appointment your doctor will review and document in the medical record your specific Bi-Level therapy usage. In addition, for continued insurance reimbursement, the doctor must document if the Bi-Level therapy is improving your health condition.
	Step 3: Prism Health Care Services will contact your doctor to obtain the medical office visit notes.
	Step 4: Your medical insurance plan will continue to pay for the Bi-Level therapy device upon receiving the medical record notes showing evidence of: 1. Bi-Level therapy device usage averaging 4 hours per night. 2. Doctor medical record note confirming your health is benefitting from the use of Bi-Level therapy.

Additional Resources:

On this page, we have also provided additional video resources for sleep apnea, and mask options.  Best of luck. We are excited to help you improve your sleep, health and quality of life.

• Sleep Therapy Equipment Overview
• myAir Patient Registration Brochure
• ResMed Video Library
• ResMed: Information about Sleep Obstructive Apnea