Replacement Supply Request Form

Are you in need of replacement supplies for your CPAP, APAP or BiPAP? Most insurances will cover the majority of your supplies every 90 days, with a few select items being only every 180 days. If you’re in need of replacement mask parts, tubing, filters or any other PAP accessory, please feel free to place your request with our Replacement Supply Request Form below, or by calling 1(800)758-7571. Our Re-Supply Team will verify your insurance and eligibility, and ship your supply directly to your door with no shipping fees. We may also contact you within 2 business days if payment is required, any problems arise, or our Re-Supply Team has questions or needs clarification on something. Please allow 5 – 7 days for shipping.

Supplies Needed

You can click the box below to be sent all the supplies you are eligible to have covered by your insurance, or you can pick the particular supplies you need individually. Please note that you will be sent the quantity which you are eligible for a 90 day period. For example, if you order CPAP Filters (Disposable) you will be sent a quantity of 6, since they are recommended to be replaced about every two weeks.

Mask Supplies

 Complete Full Face Mask with Headgear Complete Nasal Cushion Mask with Headgear Complete Nasal Pillow Mask with Headgear Full Face Mask Frame Nasal Cushion Mask Frame Nasal Pillow Mask Frame Full Face Mask Cushions Nasal Mask Cushions Nasal Pillows Full Face Mask Headgear Nasal Mask Headgear Nasal Pillow Headgear

Other Supplies

 Standard Tubing Heated Tubing CPAP Filters (Disposable) CPAP Pollen Filters Water Chamber Chinstrap

Please use the following section if you have any comments or special instructions for the supply shipment. Please note that there are many variations of most types of supplies. You will be shipped the same products that Advanced Homecare most recently provided to you during the previous supply period. For example, if you order Nasal Pillows, and the last mask you were dispensed by Advanced Homecare is the Philips Respironics Nuance Pro Nasal Pillows, we will send you Nasal Pillows for the Nuance Pro. If you require a change, please detail here:

Has your insurance changed since the last time you received supplies or your PAP machine from Advanced Homecare?