Navigating the Insurance Reimbursement Process for Zzoma

 

Medicare & Medicaid Services:

Zzoma is generally an out-of-pocket expense because Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) believes code E0190 “POSITIONING CUSHION/PILLOW/WEDGE, ANY SHAPE OR SIZE, INCLUDES ALL COMPONENTS AND ACCESSORIES” adequately describes the product. This code has a payment schedule of $0.00.  While Medicare will not pay for the device some state and/or local Medicaid services pay for E0190 products. Please contact your policy representative to find out more information about HCPCS code E0190.

Private Carriers:

Many of the private carriers follow government regulations for payment coverage. Therefore, many of the private carriers are yet to assign Zzoma its own paid reimbursement code.   For this reason, each reimbursement claim is an individual review.  Patients have a greater chance in receiving their money back if they file a refund/reimbursement claim themselves. In other words, Zzoma is an out-of-pocket expense that you may be refunded for.

If you’d like to receive pre-authorization for a refund we suggest for you to start by calling the 800 # on the back of your insurance card.  Ask them their policy on the equipment code E0190 as a medical necessity.  Explain to the customer care representative that you have been diagnosed with obstructive sleep apnea and have been prescribed Zzoma as a medical device.  Let them know that you do have a medical necessity letter.  E0190 is a code that receives reimbursement only if the claim reviewer understands your product is medically necessary. They must be convinced that that you are buying this device to improve your health.

Most insurance companies will have you purchase items and then download a claim form from their website.  We suggest submitting a copy of your prescription, medical necessity letter, and product receipt with your application form.   We are not given permission to access your health coverage so please be sure to write your own contact information on the forms for correspondence.

The following information is a collection of the details you may need for your refund.

Manufacturer/Servicing Provider Name: Sleep Specialists, LLC (DBA 2Z Medical)

TAX ID:  20-5914787

Mailing Address: 150 Monument Rd, Suite 207, Bala Cynwyd PA 19004

Telephone: 1.877.799.9662

Fax: 1.267.222.1000

Production Name: Zzoma Positional Device

Regulatory Class: Class II (prescription only)

FDA Clearance 510(k): K100160

ICD-10 Diagnosis Code: G47.33 or Obstructive Sleep Apnea

HCPCS Code/Equipment Code: E0190

Cost: $189.95

*If your insurance company does not cover for Zzoma, it may be covered under your pre-tax cafeteria plan (IRS Section 125).

 

Navigating the Insurance Reimbursement Process

Zzoma is an out-of-pocket expense that you may be refunded for by your private healthcare insurer. Refund approval and percentage depends on your policy.

If you'd like to receive pre-approval we suggest for you to start by calling the 800 # on the back of your insurance card. Ask them their policy on the equipment code E1399 as a medical necessity. Explain to the customer care representative that you have been diagnosed with obstructive sleep apnea and have been prescribed Zzoma as a medical device. Let them know that you do have a medical necessity letter (click for a sample).

Most insurance companies will have you purchase items and then download a claim form from their website. We suggest submitting a copy of your prescription, medical necessity letter and receipt with your form. We are not given permission to access your health coverage so please be sure to write your own address on the forms for correspondence.

The following information is a collection of the details you may need for your refund.

Manufacturer/Servicing Provider Name: Sleep Specialists, LLC (DBA 2Z Medical)
TAX ID: 20-5914787
Physical Address: 45 E City Ave PMB 325 Bala Cynwyd PA 19004
Telephone: 1.877.799.9662
Fax: 1.267.222.1000
Active HCPCS Code/Equipment Code & Description: E1399 Durable Medical Equipment Misc Code
Production Name: Zzoma Positional Device
Regulatory Class: II (prescription only)
FDA Clearance 510(k): K100160
ICD-9 Diagnosis Code: 327.23 or Obstructive Sleep Apnea

If your insurance company does not cover for Zzoma, it may be covered under your pre-tax cafeteria plan (IRS Section 125).

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Navigating the Insurance Reimbursement Process

Zzoma is an out-of-pocket expense that you may be refunded for by your private healthcare insurer. Refund approval and percentage depends on your policy.

If you'd like to receive pre-approval we suggest for you to start by calling the 800 # on the back of your insurance card. Ask them their policy on the equipment code E1399 as a medical necessity. Explain to the customer care representative that you have been diagnosed with obstructive sleep apnea and have been prescribed Zzoma as a medical device. Let them know that you do have a medical necessity letter (click for a sample).

Most insurance companies will have you purchase items and then download a claim form from their website. We suggest submitting a copy of your prescription, medical necessity letter and receipt with your form. We are not given permission to access your health coverage so please be sure to write your own address on the forms for correspondence.

The following information is a collection of the details you may need for your refund.

Manufacturer/Servicing Provider Name: Sleep Specialists, LLC (DBA 2Z Medical)
TAX ID: 20-5914787
Physical Address: 45 E City Ave PMB 325 Bala Cynwyd PA 19004
Telephone: 1.877.799.9662
Fax: 1.267.222.1000
Active HCPCS Code/Equipment Code & Description: E1399 Durable Medical Equipment Misc Code
Production Name: Zzoma Positional Device
Regulatory Class: II (prescription only)
FDA Clearance 510(k): K100160
ICD-9 Diagnosis Code: 327.23 or Obstructive Sleep Apnea

If your insurance company does not cover for Zzoma, it may be covered under your pre-tax cafeteria plan (IRS Section 125).

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Zzoma Application Instructions:

  • Place the device on your back and bring the straps around so they are in front of you.
  • Position the device so the Velcro straps are at the level of your chest.
  • Adjust the Velcro straps for fit and comfort and secure together.
  • Lie on either side in a comfortable position and go to sleep.

Warning:
The user of this pillow should consult with their physician if the following symptoms continue:

  • Frequent excessive daytime sleepiness
  • Periods of not breathing, as observed by bed partners
  • Awakening short of breath, choking or gagging
  • Heavy snoring
Contraindictions:
  • A history of heart diseases
  • Being substantially overweight
  • Not for use by infants or children
  • Do not use if pain or discomfort results

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Cleaning Instructions:

  • Remove the foam wedge from the nylon pack.
  • Hand wash the nylon pack in cold water with a mild detergent and allow to air dry.
  • Once dry, reinsert foam wedge and seal the Velcro closure.
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