Customer Financial Assistance Program
RespirTech recognizes some patients do not have adequate financial resources to help pay for the inCourage® System and may need financial help. Because we are dedicated to working with patients to help maintain and improve their quality of life, we have developed a program to help eligible patients with their payment obligations, not covered or mandated by their insurance programs.
Patients are referred to the Customer Financial Assistance Program by RespirTech’s Customer Care or Finance Department. Upon referral, we will contact the patient with additional information and provide an Application for Customer Assistance.
Patient, or patient’s representative, will submit the following to RespirTech:
- Completed application
- Copy of the first two pages of their most recent Federal tax return, (parental information is required if the patient is a minor), or
- If patient is on Social Security and that is the patient’s sole income source, their most recent Social Security statement.
All information is treated confidentially and will be used only to determine if the patient qualifies for financial assistance.
Once the required documents have been submitted, they will be reviewed to determine if the patient meets the assistance criteria. If the patient qualifies, assistance may be awarded. Patients will be notified within 30 days of receipt of the required documents regarding qualification and the level of assistance provided. RespirTech also offers interest-free payment plans to those patients who do not qualify for any assistance or those that qualify for partial assistance.
Who do I contact for more information?
Patients, patient representatives and health care providers may contact us regarding the Customer Assistance Program at 800.793.1261 or by email.