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Customer Service Agreement

The following outlines a description of our terms and conditions. 

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SUMMARY

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  • Engaging with us gives consent to ask about and accept our services which includes, not limited to, equipment, supplies, insurance filing, and advocacy.

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  • Therapy management and outcomes is the responsibility of you and your physician so we may need a prescription for some items or services.

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  • You authorize us to work with your protected health information for your benefit limited to obtain required medical and insurance information.

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  • You will not hold us for liable of harm for providing reasonable service within the industry standard and scope of care.

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  • You accept the ultimate responsibility for payment, which includes if using your insurance benefit, deductibles and rentals if applicable depending on your insurance plan.

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  • You agree to pay your portion of all rental payments at time of service if applicable.

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  • If you are using your Medicare benefit, you understand that you must follow Medicare rules for Medicare to pay.

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This Agreement is effective January 18th, 2023.

 

ACCEPTANCE OF SERVICES AND MEDICAL RESPONSIBILITY

 

Requesting services by phone, email, or in person from PneuCare implies consent and authorization for services and products. We will ask for some affirmative documentation for some services.

 

Your ordering physician is solely responsible for diagnosing and prescribing CPAP therapy and otherwise medically supervising and managing a patient’s therapy. It is your responsibility to remain under the care supervision of your ordering physician.

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While, PneuCare cooperatively works with a patient’s physician in as much as appropriate for advocacy within scope of a respiratory therapist license, the treating physician is solely responsible for directing the patient’s plan of care including, diagnosing and prescribing medication and therapy for the patient’s health. PneuCare, nor any of its agents or employees, are not permitted to diagnose any condition or modify treatment without the expressed written permission of the patient’s physician.

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MEDICAL PRESCRIPTION REQUIRED FOR DEVICES

 

A medical prescription is required to release any CPAP device as required by law. Prescriptions are considered invalid after one year of date written.

 

If you need a new prescription, let us advise you. 

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RELEASE OF MEDICAL INFORMATION

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PneuCare is committed to patient privacy and exceeds local and federal mandates for protections. Information is used for a patient benefit in accordance with PneuCare Privacy Practices. We do not use or disclose any information without the expressed consent of our patients or legal representative and for only that which is required to provide related services. Personal Healthcare Information (PHI) is maintained and stored electronically in secure servers managed by a third party subject to Federal privacy laws.

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ASSIGNMENT OF INSURANCE BENEFITS

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If you are using your insurance benefit, you acknowledge that the benefit is yours to be used for you and not another individual not authorized by your plan.

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INDEMNITY

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You agree to hold no harm against PneuCare, its employees or agents for the reasonable performance of activities required to fulfill its medical responsibilities with the scope of its care that is initiated by a physician order. This includes loss or liability or claim, and any related legal fees arising from such, arising directly from you or a third party.

 

FINANCIAL RESPONSIBILITY

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PneuCare files for payment with insurance companies on behalf of the patient as a courtesy. However, beneficiaries remain soley responsible for payment, which includes deductibles, rentals, or any or all portions unpaid by their insurance company.

 

Insurance verification and approval of coverage status DOES NOT guarantee payment. Assignment of benefits to a third party does not relieve the patient of the obligation to ensure full payment. 

 

Your co-insurance and deductible amounts noted on the delivery ticket may NOT be the final amount I owe. Final balance due information will be based on final insurance reimbursement. A quote provided is a good faith estimate of what you may be responsible to pay and may be different from the actual amount you owe.

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​Rental Payments: All rentals are required up front. Some insurance plans pay for beneficiary claims through rental payments over the course of several months. We require full payment for beneficiary responsibility up front, which may include a deductible in addition to co-pay requirements. If this applies to you, you agree to providing your portion of rental payments at the time of dispensing equipment.

 

Patient’s Responsibility:

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  • Provide PneuCare with all insurance information necessary to file your claim.

  • Notify PneuCare of any changes or loss of insurance coverage.

  • Pay your deductibles, co-pays, and balances not covered by insurance.

  • You agree that as a patient or beneficiary, you are responsible for payment in full for all claims not covered by insurance. You will be informed before delivery of items not covered, and assignment will not be accepted.

 

MEDICARE CLAIMS

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CPAP devices provided are paid for by a 13-month capped rental to purchase plan pursuant to Medicare rules. You may be responsible for your monthly rental if your deductible has not been met, and your deductible may increase at the beginning of a new year according to Medicare changes or provisions. Please note that a quote provided is a good faith estimate of what you may be responsible to pay and may be different from the actual amount you owe.

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If Medicare denies payment, you will be notified. At that time, if you wish to keep the equipment, it may be converted to a private rental. If Medicare assignment is accepted, you are responsible for the 20% that Medicare does not pay. In many cases, the 20% is paid by your secondary insurance. PneuCare will follow through with the appeal process on Medicare claims that may be denied on the patient’s behalf at its discretion. This will be done on non-assigned claims at the patient’s request. However, if your claim is denied for non-coverage, you become responsible for payment.

 

MEDICARE COVERAGES SUMMARY

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  • There will be a minimum of one-month rental on all equipment rentals.

  • If you terminate your therapy, rental charges will be continually assessed until we are the equipment is returned, and may become the beneficiary's responsibility.

  • Any charges incidental to the use or operation of the equipment (such as electricity, batteries) are the responsibility of the patient.

  • All claims assigned or non-assigned will be filed on behalf of the patient.

 

Medicare Rules for Reimbursement Beyond Trial Period

  • Use PAP therapy at least 4 hours per night; and

  • Use at least 70% of the nights (21 days) during a consecutive 30-day period;

  • Anytime during the first 3 months; and

  • Meet with your physician not earlier than 31 days, and not later than 90 days for follow-up appointment.

  • Meet with your physician on your 12th month of therapy.

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Failure to meet Medicare criteria shifts responsibility for payment to the benificiary. You will either be required to pay for the equipment or return it to us as your provider.

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NON-MEDICARE COVERAGE TERMS SUMMARY

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  • For plans with rentals, all patient portion of rental payments are due at time of service for rented equipment.

  • There is a 60% of the total purchased price restocking fee of for any returned durable equipment if returned in 30 days. After 30 days, durable equipment products sales are final.

  • If the equipment is to be returned, rental charges accrue until equipment is picked-up.

  • A monitoring fee $30 will be assessed if: requested by your physician; or required by your insurance for compliance purposes.

  • Any charges incidental to the use or operation of the equipment (such as electricity, batteries, replacement supplies) are the responsibility of the patient.

  • All claims assigned or non-assigned will be filed on behalf of the patient.

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MEDICARE ADVANCED BENEFICIARY NOTICE (ABN) 

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You should notify us if you would like for us to file a claim with Medicare on your behalf. PneuCare works with commercial insurance and Medicare, and is a Medicare preferred provider, in addition to retail sales. Medicare clients that wish to pay for ineligible items will need to complete an ABN, as required by Medicare to receive products from us.

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RETURNS

 

  • Masks that are unopened and unused may be returned for a full refund within ten days of purchase.

  • All consumable equipment (masks, tubing, water tank, filters) are nonreturnable if opened. 

  • CPAP and respiratory assist devices, (BiPAP, BiPAP ST, ASV) are subject to a 60% of the full original value of the equipment restocking fee, if returned in good working order within 30 days of set-up. 

  • Customers are responsible for the full purchase price of equipment beyond 30 days of set-up (excluding Medicare).

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SEVERABILITY

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If any provision of this Agreement is held illegal or unenforceable in a judicial proceeding, such provision shall be severed and shall be inoperative, and the remainder of this Agreement shall remain operative and binding on the Parties.

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