And the surgery can cause many complications. I can't say exactly how much you'll end up paying -- it depends heavily on your insurance plan and deductible. If youve got questions around insurance coverage for Inspire, speak with an Inspire Advisor. Each time you breathe, the Inspire device sends an impulse to the hypoglossal nerve. Navigation Menu - Opens a Simulated Dialog. Your doctor will probably have you try lifestyle changes and. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. Sorry, that's wrong. Your doctor may suggest a sleep study. Sleep apnea can range from mild to severe, based on how often breathing stops during sleep. Monday through Friday, 7:30 a.m. to 9:00 p.m. Oahu:808-432-2000Maui:808-243-6000Hawaii:808-934-4000 (Hilo) / 808-334-4400 (Kona). If you have a bed partner, they may notice that you: Children who have sleep apnea nearly always snore. Kaiser Permanente is not responsible for the content or policies of external websites. Don't wear makeup, fingernail polish, or fake nails. Are you clear about which benefits and side effects matter most to you? CPAP is doing wonders for my sleep apnea. 2011-2023 Healthwise, Incorporated. Helps you have more normal sleep, so you feel less sleepy and more alert during the daytime. They may be helpful as you make important health decisions. Health Tools help you make wise health decisions or take action to improve your health. You have moderate to severe obstructive sleep apnea. Your doctor may suggest a sleep study. An HGNS is like a cardiac pacemaker. Raise your risk of having high blood pressure in the lungs (pulmonary hypertension). That eliminates an incision and, according to Inspire, reduces the procedure time by 20%. A dentist will shape the device to fit your mouth. Adaptive servo ventilation (ASV). You may be asked to keep a sleep diary before your sleep study. Follow us on these external social media sites that will open in a new browser window. Inspire is a popular alternative to the CPAP machine. Sleep apnea increases as people get older. or Your blood oxygen levels will be checked by a small clip (oximeter) placed either on the tip of your index finger or on your earlobe. Details. For some tests, you will also stay part of the next day. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. But they may not give the same results as a sleep lab. How often should my doctor check the Inspire system? During a routine checkup, your doctor will ask you and your child about snoring. 1. Other risks may include: Scar tissue forming at the opening of the hole in your throat. Do you have enough support and advice from others to make a choice? Servicio a los Miembros (rea metropolitana), Servicio a los Miembros (fuera del rea metropolitana) 1-800-777-7902 (TTY 711). Ongoing problems that have not responded to treatment. The exact out-of-pocket cost will depend on your insurance plan. Sleep studies are a series of tests that look at what happens to the body during sleep. This makes your heart and blood vessels work harder and can affect your heart rate and nervous system. That's because you aren't snoring or restless. of sleep, attended by a technologist or more additional parameters of sleep, attended by a technologist 18.02 95800 Home sleep test, unattended, Type III (Commercial) 4.88 95801 Home sleep test, unattended, Type IV (Commercial) 2.62 95806 Home sleep test, unattended, Type III (Commercial) 2.94 I have been using continuous positive airway pressure (CPAP) to treat my sleep apnea for over a year. The main side effect of tracheostomy is that you have a hole in your throat where the breathing tube sits. Register. Sleep studies are tests that watch what happens to your body during sleep. Each patient will have one incision under the chin and one below the collarbone. To learn more about Healthwise, visit Healthwise.org. For more information, please visit. But watchful waiting may not be right if you notice that your sleep partner snores loudly and heavily, is restless during sleep, and is sleepy during the day. If you don't use it, your symptoms will return right away. Apnea episodes and snoring may return over time. Not growing as quickly as they should for their age. Details. Overview The hypoglossal nerve stimulator (HGNS) is a treatment for obstructive sleep apnea (OSA). Monday through Friday, Oahu: 7:30 a.m. to 5 p.m. Medicines include some types of sleeping pills, opioids, and sedatives. The Sleep Lab at South Sacramento Kaiser Permanente is open Monday through Friday between the hours of 8:30 am and 5:00pm. If your child snores, be sure to tell your doctor. For recommended treatments, please consult with your health care provider. Oral devices may be used for people who have mild to moderate sleep apnea. Blocked or narrowed airways in your nose, mouth, or throat can cause sleep apnea. You are age 18 or above. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. It's recommended that you turn it on at night and turn it off when you wake up for your day. Now there's a new alternative to CPAP machines. This is a limited benefit. Kaiser Permanente is not responsible for the content or policies of external websites. People who have sleep apnea and tend to have swelling in their lower legs and ankles may be helped by wearing compression stockings during the day. According to Inspire, the stimulation is subtle and is designed to not wake you up, meaning it shouldn't be painful or uncomfortable. For some, sleeping with a CPAP machine is impossible. It is approved to treat mixed sleep apnea, as long as central sleep apnea does not account for more than 25% of events. Successful procedures make breathing easier and decrease OSA-related symptoms. Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.,1300 SW 27thSt., Renton, WA 98057, Selecting these linkswill take you away from KP.org. It may help to go back and read "Get the Facts." A tracheostomy nearly always cures sleep apnea. Your doctor will probably have you try lifestyle changes and CPAP (continuous positive airway pressure) first. CPAP stands for "continuous positive airway pressure.". 2. Does anyone have any experience with the Inspire device? The more often it happens, the more severe your sleep apnea is. Enter X266 in the search box to learn more about "Learning About CPAP for Sleep Apnea". It delivers mild stimulation to key airway muscles, allowing the airway to remain open during sleep, Inspire is controlled by a small handheld sleep remote, Have been diagnosed with moderate to severe obstructive sleep apnea, Struggle with or cant get consistent benefit from CPAP, Most U.S. insurance companies cover Inspire, Over 400 insurance companies have covered the cost of Inspire for patients who meet the eligibility requirements, Typically, you can expect to pay any unmet deductible along with any copay or coinsurance fee for a surgery, Medicare is covered across the United States for those who meet criteria, Inspire is available for veterans at select VA and military hospitals across the US, Visit the Find a Doctor page or chat with an Inspire Advisor to see if there is a VA or military hospital near you that offers Inspire, If there is not a center near you, you can possibly utilize a program called the Community Care Program, allowing you to receive care at a civilian hospital, To contact Inspires dedicated VA Patient Liaison, email. It happens when the brain has trouble controlling breathing. Sleep apnea is often treated with machines that deliver air through a mask to help keep your airways open. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. De lunes a viernes, de 8:00 a. m. a 6:00 p. m. Horario Abierto los 7 das de la semana, de 8 a. m. a 8 p. m. Washington (fuera del rea de Vancouver/Longview), Direccin 601 Union St., Ste. In some cases, a dental device that widens the mouth can help. This most often occurs because your airways are blocked or partly blocked. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Based on FDA indications and insurance requirements, an Inspire trained doctor will determine if you meet the four criteria. The Medicare program will cover those who require the use of Inspire. My wife can't believe the change in my attitude during the day. 2023 Kaiser Foundation Health Plan, Inc. We are unable to switch you to this area of care. Other things that make sleep apnea more likely include: UPPP: Your doctor may suggest UPPP (to remove excess tissue in your throat) if: Maxillo-mandibular advancement and radiofrequency ablation: Your doctor may recommend one of these other surgical treatments if: Tracheostomy: Your doctor may recommend tracheostomy (to put a permanent opening in your neck to your windpipe) if: These stories are based on information gathered from health professionals and consumers. Your use of this information means that you agree to the Terms of Use and Privacy Policy. The Inspire device delivers what's called "hypoglossal nerve stimulation therapy" while you sleep. Some CPAP devices automatically adjust air pressure or use different air pressures when you breathe in or out. You are not significantly obese. To get the implant, you must have moderate to severe OSA and not benefit from a CPAP machine. Surgery is a first choice only if the sleep apnea is caused by a blockage that is easily fixed. Lead to other problems, such as high blood pressure and heart disease. For recommended treatments, please consult with your health care provider. I nspire is a brand which manufactures the only Food and Drug Administration (FDA)-approved device for treating obstructive sleep apnea. Things like a stuffy nose caused by a cold or allergies can make apnea worse. Sign In Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.,1300 SW 27thSt., Renton, WA 98057, Selecting these linkswill take you away from KP.org. It may help to go back and read "Compare Your Options." Once that information is recorded in your medical record, Medicare will generally cover an additional ten months of sleep apnea machine rental, for a total of 13 months, at which time, you will own the equipment outright. While you sleep, Inspire opens your airway, allowing you to breathe normally and sleep peacefully. Simply turn Inspire on before I am tired of being attached to a machine at night while I sleep. You'll avoid the risks of having surgery. It's important to treat sleep apnea, because it makes you more likely to have other serious problems. Sleep apnea occurs when you often stop breathing for 10 seconds or longer during sleep. Key points to remember If you snore but don't have other symptoms of sleep apnea, you may not need a sleep study. Enter C688 in the search box to learn more about "Sleep Studies: About This Test". I have been using CPAP. It's important to treat sleep apnea, because it makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke. This causes a little back-pressure in the airways that may help keep them open. Inspire is significantly more expensive than traditional CPAP machines, which usually retail between $250 and $1,000 -- some go into the multiple thousands. Persons who often go through obstructive sleeping experiences can try out this treatment. It's also not recommended for anyone with ". For more information, please visit. It's a small device placed during a same-day, outpatient procedure. Be ready to talk about your struggles using CPAP and any sleep-related topics including: Write down any questions you have for the doctor, The airway exam is a very routine and non-surgical exam, Youre given a short-acting medication to put you to sleep. Check what you need to do before you make this decision. Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. 1-800-464-4000 (TTY 711)Espaol: 1-800-788-0616Chino: 1-800-757-7585. Despite seeming like a minor annoyance that might keep your partner up at night, there are several serious side effects of sleep apnea if left untreated, including high blood pressure, strokes and heart issues. Radiofrequency ablation for sleep apnea can cause: Damage to tissue near the area being treated. If your nose or mouth is dry, set the machine to deliver warmer or wetter air. 1. If you don't smoke, those muscles are less likely to collapse at night and narrow the airways. It's also a good idea to keep a list of the medicines you take. This is repeated muscle twitching of the feet, arms, or legs during sleep. Inspire therapy is approved to treat a subset of people with moderate to severe OSA who are unable to use CPAP therapy. Do you understand the options available to you? No, that's wrong. 2006-2023 Healthwise, Incorporated. Lifestyle changes can help treat obstructive sleep apnea. Your doctor may suggest CPAP if you have: If using CPAP is not comfortable, or if you have certain side effects, work with your doctor to fix them. or Navigation Menu - Opens a Simulated Dialog, Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine, Request for confidential communications forms. That in turn may: Watchful waiting is a wait-and-see approach. You might be able to try another type of mask or make other adjustments. Around 22 million Americans have sleep apnea. Follow us on these external social media sites that will open in a new browser window. The risks of maxillo-mandibular advancement are: Changes in appearance and in how the teeth meet. Sleep apnea means that breathing stops for short periods during sleep. When you have sleep apnea, this can help you sleep better, feel better, and avoid future health problems. Almost all people who have sleep apnea snore. Some patients will also have one on the side of the rib cage. TRICARE may cover CPAP machines for: Obstructive sleep apnea syndrome. I am not willing to risk the complications from surgery, so I am going to continue with CPAP. Bachelor of Science, Psychology and Sociology. You notice that your bed partner stops breathing, gasps, or chokes during sleep. Conditions such as periodic limb movement disorder. Excessive snoring. Go to https://www.healthwise.net/patientEd. Enlarged tonsils or adenoids are a common cause of sleep apnea in children, so surgery to remove them is usually the first treatment. You could try to lose weight, sleep on your side, and avoid alcohol and medicines like sedatives before bed. Radiofrequency ablation, which reduces the size of the tongue or other tissue that may be blocking airflow to the lungs. For most people, lifestyle changes and/or CPAP work to control sleep apnea symptoms. Problems staying awake, such as narcolepsy. Neighbor islands : 8 a.m. to 5 p.m. Monday through Friday, 5 p.m. to 8 a.m. next day; Weekends and holidays, 24 hoursOahu: 808-432-7700Neighbor islands: 1-800-467-3011. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. The Inspire systemis the latest in obstructive sleep apnea treatment. These include: People who have sleep apnea are more likely to be obese. Your use of this information means that you agree to the Terms of Use and Privacy Policy. 100 Portland, OR 97232. Being able to feel the nerve being stimulated. The Inspire Sleep Apnea Innovation is an upper airway stimulation (UAS) treatment designed to open your airway during sleep. It's important to treat obstructive sleep apnea, because sleep apnea makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke. My appearance after a tracheostomyhaving a hole in my throatwon't bother me. Continuous positive airway pressure (CPAP), Sleep Apnea: How Treatment Can Improve Your Life, continuous positive airway pressure (CPAP), E. Gregory Thompson MD - Internal Medicine, Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine, Continuous positive airway pressure (CPAP) for sleep apnea. Oral devices (also called oral appliances) are sometimes used to treat obstructive sleep apnea. I don't like the idea of living with a hole in my throat. Medical Review:Anne C. Poinier MD - Internal Medicine & E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine & Lesley Ryan MD - Family Medicine. Use this Prior Authorization Guide to assist you in determining if your patient meets criteria.. All Rights Reserved. or Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Getting up often during the night to urinate. After menopause, women get sleep apnea at a rate similar to men. Inspire is a sleep apnea treatment. It should not be painful or uncomfortable. Our team of advisors are here to help. What are the Operating Hours of the Sleep Lab at South Sacramento Kaiser Permanente? Tubing and other supplies for your sleep apnea machine are generally also covered at 80%. Apnea episodes may be more frequent when you have not had enough sleep. They may also be used for people with severe sleep apnea who find that continuous positive airway pressure (CPAP) doesn't work for them. This information does not replace the advice of a doctor. Follow us on these external social media sites that will open in a new browser window. Bone deformities of the nose, mouth, or throat can interfere with breathing, causing sleep apnea. Even though Inspire is approved by the FDA and by more and more insurance companies, there are multiple steps the patient and their physicians must go through before getting Inspire therapy for sleep apnea covered. Decision Points focus on key medical care decisions that are important to many health problems. Take a small overnight bag with personal items, such as a toothbrush, a comb, favorite pillows or blankets, and a book. My nose is always dry, and my sleep is not improving. 2023 CNET, a Red Ventures company. Were working to get kp.org back online as soon as possible. I'm willing to try surgery to get better. You're right. It's a sleep disorder marked by frequent breathing interruptions that can last between 10 to 30 seconds. This is done by having a sleep study. For more information on MRI Guidelines, please, To find out what Inspire Model you have, please contact your doctor or refer to your Patient ID card. Sleep Apnea: Should I Have a Sleep Study? You are unable to use or get consistent benefit from CPAP. The stimulation is very gentle and designed to move the tongue forward without disturbing your sleep. A doctor trained on the Inspire procedure can discuss the qualifications with you during an office visit. Do you have enough support and advice from others to make a choice? You can go back to your usual activities. This may happen many times during a night. Surgery can sometimes correct these deformities and improve sleep apnea. Inspire improves airflow and reduces obstructive sleep apnea . If your sleep apnea doesn't improve with treatment, you may have more tests to find out what's causing it. New comments cannot be posted and votes cannot be cast. Most sleep apnea patients who meet eligibility requirements for Inspire have access to insurance coverage. Spice up your small talk with the latest tech news, products and reviews. If you need help with Kaiser Permanente services or have questions, please see the phone numbers by state/area below. Monday through Friday,7:30 a.m. to 7 p.m.Saturday and Sunday,8 a.m. to 4:30 p.m. Estamos trabajando para restaurar el sitio kp.org/espanol lo antes posible. Sleep apnea and coronary artery disease (CAD). Think about what matters most to you in this decision, and show how you feel about the following statements. Other forms of surgery are not right for you. If you have moderate to severe sleep apnea, you may need to use a breathing device (continuous positive airway pressure CPAP) that prevents your airway from closing during sleep. cross-references to other topics, definitions or medical illustrations) is only available in the online version. CPAP is a small machine that you use at home every night while you sleep. Kaiser Permanente is not responsible for the content or policies of external websites. Inspire Medical Systems, Inc. 2023. Nerve stimulation. I am willing to have surgery to treat my sleep apnea if it can help. Want CNET to notify you of price drops and the latest stories? Have nighttime choking or gasping spells. Mark Klimek. You may not need to use CPAP after surgery. and our However, if you're living with sleep apnea and finding no relief with the usual treatments, the Inspire implant may be right for you. 2006-2023 Healthwise, Incorporated. Show which way you are leaning right now. Your doctor will probably do a physical exam and ask about your past health. 2023 Kaiser Foundation Health Plan, Inc. We are unable to switch you to this area of care. There are risks with all kinds of surgery, including infection, bleeding, and a bad reaction to anesthesia. You're right. Follow us on these external social media sites that will open in a new browser window. It also reduces the chance that tissue will collapse and narrow the airway when you breathe in. It is the first treatment choice and the most widely used. Nasal disks have a valve that makes it harder for you to breathe out. Sign In She has invested hundreds of hours into studying and researching sleep and holds a Certified Sleep Science Coach certification from the. Respiratory insufficiency. You can help prevent obstructive sleep apnea if you try the following ideas. Designed to make shopping easier. There are two or three incisions made to place the device. Talk to your doctor or pharmacist about your options. Remember, it's an outpatient procedure, so there are some medical bills that will have to be taken into account. Sometimes medicine that helps you stay awake during the day may be used along with CPAP. The Inspire device is placed during a minor surgical procedure, but you can usually go home the same day. A tracheostomy nearly always cures sleep apnea. It may cost you from $40,000 to $60,000 to implant the inspire device and make a clear breathing airway. It really isn't that much of a bother for me to use. Some insurance won't approve it. Le pedimos disculpas por cualquier inconveniente y agradecemos su paciencia. Sleep labs are often located in hospitals. You will probably be asleep during surgery. You start at lowest level and go up every week. This information does not replace the advice of a doctor. Kaiser Permanente is not responsible for the content or policies of external websites. These studies can help find sleep problems, such as: Follow-up care is a key part of your treatment and safety. Central sleep apnea is less common. Sleep apnea is called either mild, moderate, or severe. Here's a record of your answers. The Inspire system is controlled by a small handheld sleep remote. Navigation Menu - Opens a Simulated Dialog. It may help to go back and read "Get the Facts." Lifestyle changes and CPAP may not be enough if your sleep apnea is very bad. Obesity is the factor most likely to lead to sleep apnea. Sign In Inspire works inside your body with your natural breathing process to treat obstructive sleep apnea. Do you need treatment even if your sleep apnea doesn't bother you too much? A Continuous Positive Airway Pressure (CPAP) machine is also known as a respiratory assist device. People who are overweight may have extra tissue around their neck, adding to their risk for sleep apnea. Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.,1300 SW 27thSt., Renton, WA 98057, Selecting these linkswill take you away from KP.org. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. It increases air pressure in your throat to keep your airway open. If you have a bed partner, they may notice that during sleep you stop breathing, often snore loudly, gasp or choke, or toss and turn. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. CPAP is a machine that prevents your airways from closing during sleep. Request for confidential communications forms. I don't want to go through surgery if there's a chance I'll have to go back to using CPAP anyway. You choose not to useor cannot useCPAP to treat your sleep apnea. This may happen 5 to 50 times an hour. This information does not replace the advice of a doctor. Or it might take place at a sleep center, where you will spend the night. Does Medicare Cover Inspire For Sleep Apnea? Your child snores, has trouble breathing while sleeping, sleeps restlessly, wakes up often, or is very sleepy during the day. Your airway can become narrowed when your throat muscles and tongue relax during sleep. What sleep apnea treatment options exist? Get in touch with an Inspire Advisor. Try using devices that you attach to the outside of your nose to help with breathing while you sleep. This most often occurs because your airways are blocked or partly blocked. They check for how often you stop breathing or have too little air flowing into your lungs during sleep. Author: Healthwise StaffMedical Review: Anne C. Poinier MD - Internal MedicineE. Sorry, you're wrong. Sore throat, incision pain, and muscle soreness. Nose strips widen the nostrils and improve airflow. Details. If your breathing stops, you may make grunting, gasping, or snorting sounds and restless body movements. Oral or nasal breathing devices may also help. To start, let's talk about what sleep apnea is. All Rights Reserved, Inspire works inside your body with your natural breathing process. Children may need to see a specialist if they have sleep apnea. If you're interested in Inspire for treating your obstructive sleep apnea, I recommend that you speak to your doctor to assess your needs and if it's a good fit for you. Children may also be treated with CPAP or corticosteroid medicine. Consultas sobre citas y consejos de salud : Copyright 2017 Kaiser Foundation Health Plan, Inc. Woodland Hills and surrounding areas (including western Ventura): Antelope Valley: 1-877-554-4404 (TTY 711), Baldwin Park y alrededores: 1-800-780-1277 (TTY 711), Downey y alrededores: 1-800-823-4040 (TTY 711), Fontana, Ontario y alrededores: 1-888-750-0036 (TTY 711), Condado de Kern: 1-877-524-7373 (TTY 711), rea metropolitana de Los Angeles: 1-800-954-8000 (TTY 711), Condado de Orange: 1-888-988-2800 (TTY 711), Panorama City y alrededores: 1-888-778-5000 (TTY 711), Riverside y Coachella: 1-866-984-7483 (TTY 711), Woodland Hills y alrededores (incluido el oeste de Ventura): 1-888-515-3500 (TTY 711).
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