“There are no secrets to success. It is the result of preparation, hard work, and learning from failure.”– Colin Powell
We are Idaho’s number one CPAP Solution Center. This is more than just a slogan on our website, but our motto is to be the best in all aspects of patient care from the moment we get their referral from the physician to the moment we meet them the first time to the years of service we provide to them with ongoing support, monitoring and reporting, and our automatic resupply program. We have never been satisfied with being just a Durable Medical Equipment company buying and selling CPAP equipment to those who have been diagnosed by a medical professional as having a sleep disorder. We want to be our patient’s sleep care advocate, and our success lies in our preparation.
Durable Medical Equipment Provider (noun): A DME (Durable Medical Equipment) business is a company that supplies and sells healthcare-related equipment and supplies that has been prescribed by a physician and is intended for use in the home for an extended period.
“We are your sleep care advocates, not just a provider of CPAP equipment and supplies.”– Everything CPAP
Our mission and vision are intertwined in that patient care and comfort is our focus so that we can provide the best nights’ sleep to our patients. With professional trainings, fittings, an open line of communication, and ongoing customer support with regular check-ins, we have one of the highest adherence rates of long-term CPAP usage in the state, as well as being above the national average.
The owners and employees of Everything CPAP are dedicated to the improvement and extension of our patient’s lives through personalized care, use of state-of-the-art equipment, constant innovation, and clinical research.
Everything CPAP will serve the people of the greater southwest Idaho region with a comprehensive approach to sleep apnea care through the integration of education, instruction, clinical research, excellence in follow up, and a personalized approach to treatment.
That personalized care starts before we even meet the patients for the first time. Let’s take a Behind-the-Scenes look at how put the patients’ needs first and ensure we are doing all we can from day one to facilitate a better night’s sleep as well as improved health.
STEP ONE: MEDICAL REFERRAL AND DATA COLLECTION
Before a patient can receive CPAP therapy, they must complete a sleep study that was ordered and reviewed by medical professional or physician who specialize in sleep disorders (including internal medicine or primary care doctors, physician at a sleep center, as well as pulmonologists, otolaryngologists, neurologists, and psychiatrists).
Once the physician diagnoses them with a sleep disorder, then we receive the referral with the patient’s information which includes:
- patient’s demographics: name, date of birth, contact information, medical insurance information including their DME specifications included in their plan;
- a valid prescription order with pressure settings of the CPAP device;
- a copy of the sleep study results with medical diagnosis of sleep apnea or similar sleep disorder;
- Letter of Medical Necessity from their referring physician; and
- the physician’s chart notes, including the degree of apnea, from moderate to severe, and the recommended CPAP treatment options.
NOTE: In collecting, storing and utilizing any and all patient paperwork, Everything CPAP strictly abides by the Federal Paperwork Reduction Act, which was enacted to minimize the burden on the public when collecting information, especially by using technology, maximize the practical use of the information collected, promote openness and accountability in the collection and use of information, and improve integrity, quality, security, and utility of information to all users within and outside the Federal Government.
If any of the above pieces of data are missing or were not completed sufficiently, our administrative team will communicate with the doctors, sleep centers and health care facilities of the patient to ensure all is complete and accurate before the patient is even contacted. Rather than delay the process of having the patient take that responsibility on, we contact the referring doctors immediately, who we more than likely already have a working relationship with.
This service of data collection and verification is not required but it’s a service we provide to make the process as seamless and effortless for the patient. We want our patients to focus rather on their sleep hygiene and the introduction and adjustment of CPAP therapy in their lives.
STEP TWO: VERIFICATION OF MEDICAL INSURANCE FOR THE PATIENT
Once our team has all the data, required referral information, and insurance-required paperwork, we begin the work of verifying the patient’s insurance in reference to their DME equipment allocation. While most insurance plans partially cover the costs of CPAP machines and related equipment, the variables include insurance company, insurance plan types, deductibles and copay rates, network of care limitations, and finally prescription and DME coverage percentages.
[For more information, please read our blog: Q&A on Patients’ Rights and Responsibilities Regarding Insurance Coverage of their CPAP Devices]
Once the eligibility and insurance benefit details are received, our administrative patient service team reaches out to the patient to disclose what they can expect with their personal monetary responsibility after insurance. We inform the patient before we even set up the appointment so they understand and can budget the cost of their new CPAP therapy. *These estimates of coverage and patient responsibility are based on the best information provided by the patient’s insurance company, thus we cannot guarantee estimates.
Once we have spoken to the patient, and the insurance information is conveyed to them, our patient service team schedules their first appointment with one of our Sleep Therapists. And all the necessary information is sent to the therapist so they can review and prepare for the first visit. That first visit can be in person or completed via Telehealth, according to the patient’s preferences and convenience.
To prepare for their first visit, our team of administrative support and therapists have spent an average of 2 or more hours of behind-the-scenes work. We feel the effort and time to go into each patient is time well spent as we are dedicated to the improvement and extension of our patient’s lives through improved sleep quality.
STEP THREE: PATIENT’S FIRST VISIT
Before the patient walks in the door, the therapist reviews all chart notes, sleep study results and any other medical information that has been provided by the referring physician so they can develop a game plan before their first visit.
The designated sleep therapist will then meet with the patient, ask questions about their condition, and sleep habits, as well as answer any the patient’s questions or concerns they may have. Some typical sleep habit questions that will be asked that first visit:
- Are they a nose or mouth breather?
- Are they a side sleeper or stomach sleeper?
- What medications are they taking and what, if any, comorbidities have they been diagnosed with?
- Do they suffer from claustrophobia or any other conditions that would inhibit wearing of any type of mask?
The following will also occur on the first meeting:
- Go over the patient’s welcome packet and information;
- Review and get signature for HIPAA required forms;
- Inform the patient what CPAP is, how it works to treat obstructive sleep apnea and better understand how it will improve their overall sleep quality;
- Educate and train patient on how to setup, disassemble, clean and maintain their CPAP equipment and supplies; for example, how to clean and fill the water chamber, how to replace filters, how to adjust settings, how to use heated tubing, and so on;
- Conduct a fitting to properly fit and train the patient on their chosen CPAP mask. (We offer a Mask Fit Guarantee: Everything CPAP offers an unconditional Mask Fit Guarantee with over 200 mask options, proper fitting by our staff at our initial visit as well as ongoing support for our patients.)
- Review the approved resupply schedule with the patient (see below for typical schedule).
Review of Recommended Adherence Schedule
Therapists will then review the patient’s deductible or patient billing responsibility, as well as what their insurance requires of the patient for compliance to approve payment. The patient is required to comply with the insurance mandated CPAP adherence schedule, which is in most cases as follows:
- The CPAP device will be rented for 10 months (Depending on patient insurance)
- The CPAP device needs to be used a minimum of four (4) hours per night for twenty-one (21) nights out of thirty (30) days each month. That is a rate of 70% compliance in a 30-day month.
- Once the CPAP adherence rate of 70% is reached for ninety (90) days, the DME company will submit preauthorization for next 3 months of the 10 month rental period.
- If for any reason, the patient has not met the 70% adherence rate, our team will reach out to the patient to understand the reasons behind their non-compliance, fix any issues, and reach out to the referring physician for changes in their prescription, including pressure settings.
After the appointment is completed, the patient will pay the estimate of the patient responsibility, as well as cost of supplies and first month rental of the CPAP device (all of which is based on their Insurance’s Eligibility and Benefits).
If for any reason, the initial claim is denied, our administrative team will persistently monitor, review reasons for denial and resubmit the claim to ensure that the patient is able to utilize their insurance benefits.
STEP FOUR: 90-DAY CHECK-IN AND REAUTHORIZATION
Over the next 30 days there will be multiple interactions with Everything CPAPS clinical therapist. They will follow up with you at minimum of; 1-week, 3-week, and 1-month intervals to ensure therapy is going as planned by the patients medical provider. Once the 90-days compliance requirement is met, our therapists schedule another meeting with the patient to go over their CPAP device monitoring results, provide recommendations to improve comfort, answer any questions or concerns and encourage continued adherence. We will also review their resupply schedule to ensure they have all that they need.
Our patient customer care team will then apply for another prior authorization for the subsequent 90 days (3 months) from the patient’s insurance company. This can only be submitted if the patient has complied with required adherence rate of the first 90 days. Every three months, this will be resubmitted to the insurance company to ensure the patient’s CPAP therapy is covered.
So that means, our administrative team is working continuously on our database of all patients to submit prior authorizations for the coming three months so there is no lapse in coverage. This takes a great deal of time and effort, as we may need to reach out the patient’s referring physician or insurance company to acquire their 3-month authorization. We have developed an efficient system in our database to provide weekly reports of which patients are ready to begin the process of their upcoming three-month authorization, so no one is missed or forgotten.
Once the patient receives ten (10) months of adherence, the patient will own their device. Prior to ten months, the CPAP equipment is on a rent-to-own basis. Regardless of how long the patient has been using the device, their insurance company can at any time request adherence data, current prescription information and chart notes. A physician’s prescription is good for one year and will need to be resubmitted by the referring physician each year.
STANDARD RESUPPLY SCHEDULE
The supplies are generally subject to your deductible and coinsurance. Being eligible for supplies does not mean that your insurance will cover the cost of any or all of the supplies. A standard insurance replacement schedule is shown below:
(1) full face mask cushion
(2) nasal mask cushions
(2) disposable filters
Every 3 months:
(1) full face or nasal mask (this does not include the headgear)
(1) heated tube
Every 6 months:
(1) non-disposable filter
Regardless of the preparation, time and effort, it is our continued goal to make sure we do everything we can to help you have a great experience from the first time you come in and every time after for years to come. We are here to help, to answer your questions, address any concerns and adjust according to our patient’s changing lives and needs, whether you’ve been our patient for one day or many years.
See recent patient testimonials:
“We have had excellent service at Everything CPAP! Their respiratory therapist has checked in on us regularly. When we have any questions he answers them in a timely manner. He is always positive and makes my son feel comfortable. This experience has helped my son in so many ways! Thank you!”– Brady French, Google Review
“Absolutely wonderful to work with. Thank you for your wonderful help. I appreciate you reaching out to make sure everything is ok and there’s no question needing answered. If you need CPAP equipment or help, I would highly recommend this place.”– Dianna Purvis, (5 star Google Review)
“Great people, great service and great attitude! Melissa was awesome, helped me find a new mask that works better and is more comfortable than any previous and she makes sure I always have what I need for a great nights sleep!”– Lane Piva, Google Review
“Absolutely excellent local business. The respiratory therapist at Everything CPAP has always been super helpful, the office staff are always pleasant and helpful, and I’ve never hand anything but an absolutely five-star experience with Everything CPAP. I’ve recommended family and friends to shop local over mail-order, and everyone has been amazed by the quality of the experience and the people. Couldn’t recommend a company more.”– Mister Oregon, Google Review