Change Healthcare Notice

Philips Recall: CareFirst Implements Replacement Process

Posted on 2021-12-14 | Updated on 2022-01-24 14:41:01

In July 2021, CareFirst BlueCross BlueShield and CareFirst BlueChoice (CareFirst) notified you that we were made aware of the Philips Recall for BiLevel Pap, CPAP and Mechanical Ventilators.

CareFirst has closely monitored the situation since then and communicated with several of our large Durable Medical Equipment (DME) partners to understand how we can best serve members impacted by the recall. We’ve heard from our members — your patients — who are concerned about not receiving a replacement device through Philips promptly.

As of today, for eligible members, CareFirst will treat the recalled devices as non-functioning and replace them before the typical five-year period. CareFirst will also pay for a replacement device, so that members might receive their new device sooner. CareFirst will reimburse all or part of the purchase for members who have already bought a replacement device out-of-pocket. Also, we will waive the requirement for a repeated sleep study prior to replacing a recalled device.

Note: Members are still required to pay their normal cost-share for replacement devices.

Who is Impacted?

The process outlined below is for all impacted Commercial and Federal Employee Program (FEP) members for dates of service on or after June 14, 2021.

If a member is enrolled in FEP and has requested an immediate device replacement, their cost-share and pre- or post-service medical review will be waived.

Important note: Members who already received a replacement device from Philips are not eligible.

What is the Process?

Members and providers must register for a replacement device through Philips before starting the replacement or reimbursement process through CareFirst.

Process 1: Replacing a Recalled Device through a Provider

Step 1

The member contacts the physician who prescribed their device and schedules an appointment (in-person or virtual). The physician confirms the equipment is necessary during the appointment and prescribes a replacement device.
Step 2

The member contacts the in-network provider they used previously and presents the new prescription from their physician.

Important Note: If a member doesn’t want a replacement device through Philips, they should call customer service to find another in-network provider. The customer service phone number is on the back of the member ID card.
Step 3 The provider verifies the member’s device is on the recall list and orders a replacement device
Step 4

The provider will submit a claim to CareFirst, with the following information:

  • The recalled device’s model number in the notes section of the claim form.
  • The RA modifier indicating the reason for replacement.
  • A copy of the prescription or medical order from the physician.
  • Any additional supporting documentation that shows that the member’s existing device was on the recall list.
Step 5

CareFirst receives and processes the claim

Process 2: Reimbursing a Member-Purchased Replacement Device

Step 1

The member logs in to My Account and follows instructions on how to submit a claim online. On a claim, the member should include:

  • Details on the recalled device, including model number
  • The receipt for the newly purchased replacement device
Step 2

CareFirst verifies the device is on the recall list and processes the claim.

Questions?

If your patients have any questions about this process, they should call Member Services, which is listed on the back of their ID card.

For questions about the Philips device replacement process, reach out to your Provider Relations Representative.