CPAP Refill

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 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:

• Full Face Mask
  (Medicare: 1 every 3 months)
• Nasal Mask
  (Medicare: 1 every 3 months)
• Oral/Nasal Mask
  (Medicare: 1 every 3 months)
• Full Face Mask Cushion
  (Medicare: 1 each month)
• Nasal Cusion
  (Medicare: 2 each month)
• Nasal Pillows
  (Medicare: 2 each month)
• Oral Cushion for Oral/Nasal Mask
  (Medicare: 2 each month)
• Headgear
  (Medicare: 1 every 6 months)
• Flex 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)

Additional Information

Other Concerns

Note or Special Instructions: