Sleep & Respiratory Modalities

Contact us toll free at 1-877-290-8636

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WELCOME TO OUR CRSCP

CPAP Re-Supply Concierge Program

Do you need a new mask, cushions, pillows, tubing, and filters for your CPAP therapy? Use our handy CPAP Re-Supply Concierge Program form below to get the necessary supplies you need for your therapy or phone us at 877-290-8636 option 3.

Personal Information

* Denotes required fields

Insurance Information

  • *
  • Has your insurance has changed since the last time you received supplies, or you are a new customer to our CPAP Re-Supply Concierge Program?

When would you like to pick up your order?

  • Please allow 48 hours to process your order, or 4 days if order is placed on Saturday.
  • If your insurance has changed since the last time you received supplies, please contact a home medical representative from your respective location.
  • For those with Medicare insurance: Medicare determines the frequency that you can receive certain items. Those time periods are shown below in parenthesis.
  • Customers with commercial insurance plans: We can bill most insurance carriers and they typically will cover these items every 3 - 6 months. Your home medical representative will determine what you are eligible for under your plan.
  • All insurance plans: You will be responsible for any deductible or co-pay before we can bill your insurance.

Please select the supplies that you would like to have refilled:

Items to Order Manufacturer Item Name / Item # Size
Full Face Mask (Medicare: 1 every 3 months)
Full Face Mask Cushion (Medicare: 1 each month)
Nasal Mask (Medicare: 1 every 3 months)
Nasal Pillows (Medicare: 2 each month)
Oral/Nasal Mask (Medicare: 1 every 3 months)
Oral Cushion for Oral/Nasal Mask (Medicare: 2 each month)
Headgear (Medicare: 1 every 3-6 months)
PAP Tubing (Medicare: 1 every 3 months)
PAP Heated Tubing (Medicare: 1 every 3 months)
Disposable Filters (Medicare: 2 each month)
Reusable Filters (Medicare: 1 every 6 months)
Chinstrap (Medicare: 1 every 6 months)
Humidifier Chamber (Medicare: 1 every 6 months)

Please send me all supplies that I am eligible for and that my insurance will cover at this time.

*Additional Information

Your health insurance may require some of all of the below information, please indicate for your health insurance will pay your items.

  • Have you seen your sleep therapy doctor within the last 12 months?

    *
  • Have you changed your mask type since your last order?

    *
  • Since you are ordering new supplies are your supplies worn, dirty, broken, falling apart?

    *
  • How many hours per day/night are you using your sleep therapy?

    *
  • How many days per week are you using your sleep therapy?

    *
  • Are you using therapy more than 70% of the time?

    *

Communicate using your CPAP Re-Supply Concierge Program, using our HIPAA secure COMMUNICATOR program. We will reply back to you with your order status using the COMMUNICATOR program also receiving an email alert notification.

Note or Special Instructions: