This PAP Therapy Resupply Terms of Service (the "Agreement") is for the purpose of Purchaser or Renter and Patient (individually and jointly, "PT") purchasing from SleepSomatics Diagnostic Center located at 2211 W Parmer Ln, Ste A, Austin, TX, 78727 and/or El Lucre Management Corp, its General Partner (individually and collectively, "SSDC") the licensed healthcare provider-prescribed Positive Airway Pressure Device Therapy Supplies and Accessories for the listed HCPCS Codes and Provider Adjusted Amounts (the "PAA") for the treatment of sleep-disordered breathing [ICD-10: G47.33] (individually and collectively, "CPAP"). PAA is established based upon the allowed or negotiated amount(s) according to PT's insurance(s). The Total Price is the maximum amount PT is responsible for under this Agreement except where indicated. This Agreement shall be considered an Exhibit to the prior-executed SSDC Service(s) Consent, SSDC Consent for Use and Disclosure of PT Health Information - HIPAA and Privacy Notice, SSDC Authorization to Release PT Medical Records, and SSDC Additional Disclosures, all duly executed by PT. PT must be physically present for pick-up, servicing, appointments, and if applicable, return of PAP at SSDC at the date and time specified in this Agreement. PAP supplies, masks, accessories, durable medical equipment, and products purchased under this Agreement are directly purchased and not billed to PT Insurance(s). SSDC makes no representation or warranty as to PT Insurance(s) reimbursement, network status, coverage, coinsurance, deductibles, policy coverage, allowable amounts, or other for the PAP supplies, masks, accessories, durable medical equipment, and products purchased from SSDC.
PAP is by prescription only by a licensed healthcare provider. PAP should never be shared with another individual. Doing so may result in infection, illness, injury, or death. PAP is an FDA Class II medical device subject to state and federal law. PT is responsible for protecting PAP from fire, water, theft, electrical surges, or any sources of ignition including smoking materials, matches, candles, fireplaces, gas ovens, burners, heaters, or similar or as recommended by the manufacturer’s instructions or warranty information. In case of an emergency, call 911 and seek immediate assistance from emergency services. In case of an emergency, immediately call 911; do NOT call SSDC.
PT has received a copy of PT's sleep-disordered breathing diagnosis and/or interpreting physician or specialist's findings. PT may decline to execute this Agreement and return to PT's treating healthcare provider for consultation regarding PT's sleep-disordered breathing and treatment options (which may include options other than PAP, such as a surgical consultation or an oral appliance). PT has been informed that untreated sleep-disordered breathing may result in hypertension, type II diabetes, mood disorders, daytime somnolence or fatigue, cognitive impairment, heart disease, heart attack, stroke, automobile accidents, and even death. By executing this Agreement, PT is choosing PAP as PT's treatment option for PT's sleep-disordered breathing.
Untreated sleep-disordered breathing is a common cause of daytime sleepiness, fatigue, impaired cognition, and reduced functioning. However, treating sleep-disordered breathing with PAP is not a guarantee that daytime symptoms will improve. PT may have other disorders, conditions, medications, or lifestyles which may cause or contribute to daytime symptoms. PT may require additional medical care or specialist referral to treat these symptoms. SSDC is not PT's physician of record. SSDC’s medical director and board certified sleep specialist may make recommendations to PT's physician or licensed healthcare provider regarding PT's PAP.
SSDC does not provide 24-hour emergency service or holiday service for PAP. Appointment availability is on a first-come, first-serve basis. SSDC makes no guarantee as to appointment availability.
All treatment options for sleep-disordered breathing have side-effects. Common PAP side-effects include soreness around the nose and mouth, irritation to the eyes, difficulty tolerating the prescribed pressure, claustrophobia, dry nose or mouth, difficulty sleeping, nasal congestion, morning headaches, and gas.
Many insurances (including Medicare) require that you are benefiting from PAP, that there be an improvement in your related daytime symptoms, and that you sleep with your PAP a minimum of four (4) hours nightly an average of twenty-one (21) days out of a thirty (30) day period. Compliance failure may result in insurance denial of insurance coverage of benefits for PAP, in which case you will be solely responsible for the TOTAL PRICE which includes all amounts due and/or outstanding for the PAP equipment, accessories, and related charges.
Timely and regular cleaning, disinfection, and replacement of your PAP in accordance with the manufacturer's guidelines is essential for optimal health and correct operation. Regular cleaning and replacement of your PAP is your responsibility. Failure to regularly clean and replace PAP may lead to air leaks, discomfort, skin irritation, contamination, infection, illness, injury, respiratory disease, and non-compliance with PAP therapy resulting in untreated sleep-disordered breathing. Untreated sleep-disordered breathing may result in hypertension, type II diabetes, mood disorders, daytime somnolence or fatigue, cognitive impairment, heart disease, heart attack, stroke, automobile accidents, and even death.
PAP purchased from SSDC is subject to the manufacturer’s warranty. Refer to the manufacturer’s documentation for warranty information of the purchased item. Manufacturer’s warranties are honored by SSDC according to applicable state of Texas law or applicable health insurances medical policies. SSDC disclaims any and all other warranties. Service or repair of PAP purchased from SSDC that is no longer covered by the manufacturer’s warranty will be subject to labor and transportation charges current at the time. Merchandise may or may not be accepted for exchange and/or refund by SSDC within thirty (30) days of PT purchase from SSDC. To obtain refund such PAP must be new, unused, unopened, undamaged, and in the original packaging. PAP refunds are subject to SSDC sole discretion.
Any individual executing this Agreement as PT in a representative capacity shall be bound personally, jointly and severally, with such fiduciary, corporation or other entity as to all obligations, expressed or implied, arising hereunder. This Agreement shall be binding upon the distributees, heirs, next of kin, executors, administrators and personal representatives of the undersigned PT.
If any portion of this Agreement is found to be in violation of any applicable law, that portion shall be struck from the Agreement while the remainder of the Agreement and its terms and conditions remain in full force and effect. For the purposes of jurisdiction, Travis County, Texas shall be the governing venue. Scanned or photocopy signatures shall be deemed identical to original signatures.