Thank you for your interest in receiving services and supplies from American HomePatient. We are pleased to serve as your provider of choice for these items. Our insurance experts conveniently submit all claims for you to ensure appropriate coverage of the products and services we provide. Please sign this Assignment of Benefits (AOB) form so that we may submit your claims to Medicare, Medicaid and/or your private health insurance provider.

CPAP Assignment of Benefits
The services and supplies ordered by your physician and provided to you may include:
CPAP Machine • Bilevel Machine • NPPV Machine • Nasal Mask • Full Face Mask • Oral Mask
Nasal Cushion • Nasal Pillow • Headgear • Chinstrap • Tubing • Heated Tubing • Disposable Filter
Non-disposable Filter • Heated Humidifier • Disposable Humidifier Chamber

Diabetic Testing Supplies Assignment of Benefits
The testing supplies may include glucose meter, test strips, lancets, lancing device and control solution

Terms of Agreement

Notice of Privacy Practices