AADSM Advocacy Alerts
Additional Support for Patients Impacted by Philips RecallAugust 12, 2021
Members have contacted the AADSM with questions about whether insurers will be making accommodations for patients impacted by the recent recall of CPAP devices. Normally, Medicare and many commercial insurers have policies in place to deny OAT coverage if the patient has been prescribed a CPAP device within the past five years.
MedicareMembers receiving OAT requests from patients with Medicare coverage should be aware that Medicare made no changes to same and similar requirements even in light of the recall of Philips Respironics CPAP devices. Medicare has published their answers to questions about the recall here: Frequently Asked Questions.
Medicare's policies on these issues cover all types of durable medical equipment, not only CPAP and oral appliances, and are established at the national, not regional, level. The AADSM is advocating with Medicare for a temporary halt on the enforcement of the policy due to the recall.
Read the AADSM Letter to Medicare
Members can download the AADSM's Same and Similar Toolkit for an explanation of the policy, description of the appeal process, and downloadable letters and checklists for referring physicians and patients.
Download the Same and Similar Policy Toolkit
Commercial InsuranceCommercial insurers will vary in their policy requirements and response to the recall. To help members advocate for their patients who want OAT, the AADSM has created a customizable letter template to use when communicating with insurers whose policies may be preventing a patient impacted by the recall from receiving OAT coverage.
Download the Insurance Letter
In addition to advocating for policy changes during the recall, the AADSM is also urging United Healthcare Group to change its recently implemented requirement for OAT prescriptions to include the make, model, and pricing of oral appliances. Read the letter here:
View the AADSM's Letter to UHG