On June 14, 2021, Philips Respironics issued a recall notification for specific brands of their continuous positive airway pressure (CPAP) machines, bi-level positive airway pressure (BiPAP) machines, and ventilators. Philips identified that this recall is expected to impact millions of users, including AmeriHealth members.
AmeriHealth will cover a replacement for a recalled Philips device for our members when this is the most appropriate decision according to the treating medical provider. The provider should take into consideration the individual circumstances of the member, available treatment options, and resources.
There is no member cost-share for replacement devices for members affected by the Philips recall.
Coverage requirements
Replacement devices are available for members of AmeriHealth and AmeriHealth Administrators plans when these
four requirements are met:
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Requirement
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AmeriHealth New Jersey and AmeriHealth Pennsylvania plans
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AmeriHealth Administrators plan
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1.
| The device to be replaced was a Philips device subject to recall. To view a list of devices subject to recall, please visit the
Philips recall website.
| The device to be replaced was a Philips device subject to recall. To view a list of devices subject to recall, please visit the
Philips recall website.
|
2.
| The device was secured within the last five (5) years.
| The device was secured within the last five (5) years.
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3.
| The member or medical provider registers the current device with the
Philips recall website (online or by phone). After registering the device, the member or medical provider must share the Philips confirmation number with AmeriHealth.
| The member or medical provider registers the current device with the
Philips recall website (online or by phone). After registering the device, the member or medical provider must share the Philips confirmation number with AmeriHealth Administrators.
|
4.
| The DME supplier providing the replacement device must submit the
AmeriHealth Philips Respironics Attestation form to affirm steps 1-3. The Philips confirmation number must be included in the Attestation. Submit the completed attestation form via email to
philipsrecall@amerihealth.com.* The attestation form should be submitted prior to or at the same time as the claim submission. Precertification is not required if the replacement device was secured withing the last five (5) years.
*This email is to submit attestations only. For questions, please contact Customer Service. | The DME supplier providing the replacement device must submit the
AmeriHealth Philips Respironics Attestation form to affirm steps 1-3. The Philips confirmation number must be included in the Attestation.
Submit the completed attestation form with the precertification request.
|
In addition, the DME supplier must:
- obtain a certificate of medical necessity and include in the member's file within 60 days of receipt of the new device.
- report the service as a new purchase, by appending the NU modifier to the applicable device procedure code, to be reimbursed the full purchase allowance.
To learn more about the recall, please visit the
Philips recall website. If you have questions, please contact our Customer Service team at 1-888-YOUR-AH1 (AmeriHealth New Jersey) or 1-800-275-2583 (AmeriHealth Pennsylvania).