MEDICAL POLICY – 7.01.163

Absorbable Nasal Implant for Treatment of Nasal Valve

Collapse

BCBSA Ref. Policy: 7.01.163

Effective Date: Jan. 1, 2020

Last Revised: Dec. 10, 2019

Replaces: N/A

RELATED MEDICAL POLICIES:

None

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POLICY CRITERIA | CODING | RELATED INFORMATION

EVIDENCE REVIEW | REFERENCES | HISTORY

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Introduction

Cartilage is one of the body’s connective tissues. It’s softer than bone yet strong enough to

provide structure. Different types of cartilage are inside the nose, including cartilage that makes

up the side (lateral) walls of the nose. In some cases, taking a breath in through the nose can

cause the lateral cartilage to flex or collapse, causing a blockage. There are proven ways of

treating blockages caused by problems with the lateral wall cartilage, including surgery to graft

cartilage in this area. A newer technique to try to treat breathing problems caused by lateral wall

collapse calls for implanting a device inside the nose. Over many months, the implant naturally

dissolves. During the time that it takes for the implant to dissolve, the body naturally forms scar

tissue where the implant is placed. Scar tissue is more fibrous than regular tissue. It’s thought

that natural scar tissue can then serve as permanent support for the lateral wall. These types of

absorbable nasal implants are investigational (unproven). More and longer studies are needed

to determine if this technique is safe and effective.

Note: The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria. The

rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for

providers. A provider can be a person, such as a doctor, nurse, psychologist, or dentist. A provider also can

be a place where medical care is given, like a hospital, clinic, or lab. This policy informs them about when a

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Page | 2 of 9 ∞

Policy Coverage Criteria

Procedure Investigational Insertion of an absorbable

lateral nasal implant

The insertion of an absorbable lateral nasal implant (eg,

Latera®) for the treatment of symptomatic nasal valve

collapse is considered investigational.

Coding

Code Description

CPT 30999 Unlisted procedure, nose

Note: CPT codes, descriptions and materials are copyrighted by the American Medical Association (AMA). HCPCS

codes, descriptions and materials are copyrighted by Centers for Medicare Services (CMS).

Related Information

N/A

Evidence Review

Description

Nasal valve collapse is a readily identifiable cause of nasal obstruction. Specifically, the internal

nasal valve represents the narrowest portion of the nasal airway with the upper lateral nasal

cartilages present as supporting structures. The external nasal valve is an area of potential

dynamic collapse that is supported by the lower lateral cartilages. Damaged or weakened

cartilage will further decrease airway capacity and increase airflow resistance and may be

associated with symptoms of obstruction. Patients with nasal valve collapse may be treated with

Page | 3 of 9 ∞

nonsurgical interventions in an attempt to increase the airway capacity but severe symptoms

and anatomic distortion are treated with surgical cartilage graft procedures. The placement of

an absorbable implant to support the lateral nasal cartilages has been proposed as an

alternative to more invasive grafting procedures in patients with severe nasal obstruction. The

concept is that the implant may provide support to the lateral nasal wall prior to resorption and

then stiffen the wall with scarring as it is resorbed.

Background

Nasal Obstruction

Nasal obstruction is defined clinically as a patient symptom that presents as a sensation of

reduced or insufficient airflow through the nose. Commonly, patients will feel that they have

nasal congestion or stuffiness. In adults, clinicians focus the evaluation of important features of

the history provided by the patient such as whether symptoms are unilateral or bilateral.

Unilateral symptoms are more suggestive of structural causes of nasal obstruction. A history of

trauma or previous nasal surgery, especially septoplasty or rhinoplasty, is also important. Diurnal

or seasonal variation in symptoms is associated with allergic conditions.

Etiology

Nasal obstruction associated with the external nasal valve is commonly associated with post-

rhinoplasty or traumatic sequelae and may require functional rhinoplasty procedures. A

common cause of internal nasal valve collapse is septal deviation. Prior nasal surgery, nasal

trauma, and congenital anomaly are additional causes.

Pathophysiology

The internal nasal valve, bordered by the collapsible soft tissue between the upper and lower

lateral cartilages, the anterior end of the inferior turbinate, and the nasal septum, forms the

narrowest part of the nasal airway. During inspiration, the lateral wall cartilage is dynamic and

draws inward toward the septum and the internal nasal valve narrows providing protection to

the upper airways. The angle at the junction between the septum and upper lateral cartilage is

normally 10° to 15° in white populations. Given that the internal nasal valve accounts for at least

half of the nasal airway resistance; even minor further narrowing of this area can lead to

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symptomatic obstruction for a patient. Damaged or weakened lateral nasal cartilage will further

decrease airway capacity of the internal nasal valve area, increasing airflow resistance and

symptoms of congestion.1

Physical Examination

A thorough physical examination of the nose, nasal cavity, and the nasopharynx is generally

sufficient to identify the most likely etiology for the nasal obstruction. Both the external and

internal nasal valve areas should be examined. The external nasal valve is at the level of the

internal nostril. It is formed by the caudal portion of the lower lateral cartilage, surrounding soft

tissue and the membranous septum.

The Cottle maneuver is an examination in which the cheek on the symptomatic side is gently

pulled laterally with one to two fingers. If the patient is less symptomatic with inspiration during

the maneuver, the assumption is that the nasal valve has been widened from a collapsed state

or dynamic nasal valve collapse. An individual can perform the maneuver on oneself and it is

subjective. A clinician performs the modified Cottle maneuver. A cotton swab or curette is

inserted into the nasal cavity to support the nasal cartilage and the patient reports whether

there is an improvement in the symptoms with inspiration. In both instances, a change in the

external contour of the lateral nose may be apparent to both the patient and the examiner.

Treatment

Treatment of symptomatic nasal valve collapse includes the use of nonsurgical interventions

such as the adhesive strips applied externally across the nose (applying the principle of the

Cottle maneuver) or use of nasal dilators, cones, or other devices that support the lateral nasal

wall internally (applying the principle of the modified Cottle maneuver).

Severe cases of obstruction resulting from nasal valve deformities are treated with surgical

grafting to widen and/or strengthen the valve. Common materials include cartilaginous

autografts and allografts, as well as permanent synthetic grafts. Cartilage grafts are most

commonly harvested from the patient’s nasal septum or ear.

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Nasal Implants

The placement of an absorbable implant to support the lateral nasal cartilages has been

proposed as an alternative to more invasive grafting procedures in patients with severe nasal

obstruction.

Summary of Evidence

For individuals with symptomatic nasal obstruction due to internal nasal valve collapse (NVC)

who receive an absorbable lateral nasal valve implant, the evidence includes one RCT and two

nonrandomized prospective, single-cohort studies. The relevant outcomes are symptoms,

change in disease status, treatment-related morbidity, functional outcomes, and quality of life.

Overall, improvements in the Nasal Obstruction Symptom Evaluation (NOSE) score have been

demonstrated in the study reports. Follow-up at three months in the RCT showed a statistically

significant improvement in response with the implant compared to the sham group, although

over half of the control group were also considered responders. The duration of outcomes

reporting is less than the duration of absorption of the device (18 months) and the purported

completion of the tissue remodeling phase (24 months). It is noted that a follow-up to 24-

months in this trial is ongoing. Longer follow-up in the prospective cohort studies is available,

with 24-month follow-up reported in the smaller (n=30) of the cohort studies. However, a

clinically significant difference may not be consistently apparent in small study populations.

Some patients meeting the positive responder criteria still reported severe symptoms, and 13%

of patients required an additional procedure. As reported, adverse events appeared to be mild

in severity and self-limiting, but still appeared common. At the 12-month follow-up in the larger

(n=160) cohort, device retrievals occurred in 5% of patients. The need for device retrievals

appears to occur early in the course of follow-up (one month); suggesting technical experience

limitations on the part of the operator or inappropriate patient selection. Follow-up to 24-

months in this cohort is needed. The evidence is insufficient to determine the effects of the

technology on health outcomes.

Ongoing and Unpublished Clinical Trials

A search of ClinicalTrials.gov in September 2019 identified an ongoing trial that might influence

this review is listed in Table 1.

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Table 1. Summary of Key Trials

NCT No. Trial Name Planned

Enrollment

Completion

Date

Ongoing

NCT03400787a Latera® Absorbable Nasal Implant vs. Sham Control for

Lateral Nasal Valve Collapse

150 Feb 2020

NCT: national clinical trial.

aDenotes industry-sponsored or cosponsored trial.

Practice Guidelines and Position Statements

American Academy of Otolaryngology - Head Neck Surgery

The American Academy of Otolaryngology - Head Neck Surgery (2010) released a clinical

consensus statement on the diagnosis and management of nasal valve compromise.2 Table 2

summarizes the key consensus statements relevant to this policy. The statement also indicated

that nasal endoscopy and nasal photography were both deemed useful but not routinely

required.

Table 2. Consensus Agreement: Diagnosis and Treatment of NVC

Item Statement Level of

Consensus

Definition NVC is a distinct clinical entity separate from other anatomic reasons

for nasal obstruction

Agreement/strong

agreement

History and

physical

Main symptom of NVC is decreased airflow as reported by the patient Strong agreement

Anterior rhinoscopy can be adequate for an intranasal evaluation of

the nasal valve, weak or malformed nasal cartilages

Agreement/strong

agreement

Inspiratory collapse of the lateral nasal wall or alar rim is consistent

with NVC

Agreement/strong

agreement

Increased nasal obstruction associated with deep inspiration is

consistent with NVC

Agreement/strong

agreement

Adjunctive

tests

Criterion standard test to diagnose NVC exists Strong disagreement

https://www.clinicaltrials.gov/ct2/show/NCT03400787?term=NCT03400787&rank=1

Page | 7 of 9 ∞

Item Statement Level of

Consensus

Outcome

measures

Various patient-reported outcomes (eg, visual analog scales,

satisfaction measures, quality of life scales) are valid indicators of

successful intervention

General agreement

Management Nasal strips, stents, or cones can be used to treat some patients Strong agreement

A surgical procedure that is intended to support the lateral nasal

wall/alar rim is a distinct entity from procedures that correct a

deviated nasal septum or hypertrophied turbinate

Strong agreement

NVC: nasal valve compromise.

Medicare National Coverage

There is no national coverage determination.

Regulatory Status

In May 2016, LATERA® (Spirox) was cleared for marketing by the U.S. Food and Drug

Administration through the 510(k) process (Food and Drug Administration product code: NHB).2

LATERA® is the only commercially available absorbable nasal implant for treatment of nasal

valve collapse. It is a class II device and regulatory details are summarized in Table 3.

Table 3. Absorbable Nasal Implant Cleared by the Food and Drug

Administration

Product Manufacturer Date

Cleared

510(k)

No.

Indication

LATERA® absorbable nasal

implant

Spirox

(part of Stryker)

2016 K161191 Supporting nasal upper

and lower lateral

cartilage

Page | 8 of 9 ∞

References

1. Howard BK, Rohrich RJ. Understanding the nasal airway: principles and practice. Plast Reconstr Surg. Mar 2002;109(3):1128-

1146; quiz 1145-1146. PMID 11884847

2. Rhee JS, Weaver EM, Park SS, et al. Clinical consensus statement: Diagnosis and management of nasal valve compromise.

Otolaryngol Head Neck Surg. Jul 2010;143(1):48-59. PMID 20620619

3. Fraser L, Kelly G. An evidence-based approach to the management of the adult with nasal obstruction. Clin Otolaryngol. Apr

2009;34(2):151-155. PMID 19413614

4. Spirox. Latera. 2017; http://www.spiroxmed.com/latera. Accessed December 2019.

5. Stewart MG, Witsell DL, Smith TL, et al. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale.

Otolaryngol Head Neck Surg. Feb 2004;130(2):157-163. PMID 14990910

6. Lipan MJ, Most SP. Development of a severity classification system for subjective nasal obstruction. JAMA Facial Plast Surg. Sep-

Oct 2013;15(5):358-361. PMID 23846399

7. Stolovitzky P, Senior B, Ow RA, et al. Assessment of bioabsorbable implant treatment for nasal valve collapse compared to a

sham group: a randomized control trial. Int Forum Allergy Rhinol, 2019 Jun 22;9(8). PMID 31226238

8. Stolovitzky P, Sidle DM, Ow RA, et al. A prospective study for treatment of nasal valve collapse due to lateral wall insufficiency:

Outcomes using a bioabsorbable implant. Laryngoscope. May 14 2018. PMID 29756407

9. Sidle DM, Stolovitzky P, Ow RA, et al. Twelve-month outcomes of a bioabsorbable implant for in-office treatment of dynamic

nasal valve collapse. Laryngoscope, 2019 Jun 30. PMID 31254279

10. San Nicol M, Stelter K, Sadick H, et al. Absorbable implant to treat nasal valve collapse. Facial Plast Surg. Apr 2017;33(2):233-

240. PMID 28388804

11. San Nicoló M, Stelter K, Sadick H, et al. A 2-Year Follow-up Study of an Absorbable Implant to Treat Nasal Valve Collapse. Facial

Plast Surg, 2018 Sep 19;34(5). PMID 30227454

History

Date Comments 04/01/19 New policy, approved March 12, 2019, effective July 4, 2019. Add to Surgery section. A

literature search was conducted through September 2018. The policy statement is

investigational. Added CPT 30999.

01/01/20 Interim Review, approved December 10, 2019. Policy updated with literature review

through August 2019, references added. Policy statement unchanged.

Disclaimer: This medical policy is a guide in evaluating the medical necessity of a particular service or treatment. The

Company adopts policies after careful review of published peer-reviewed scientific literature, national guidelines and

local standards of practice. Since medical technology is constantly changing, the Company reserves the right to review

http://www.spiroxmed.com/latera

Page | 9 of 9 ∞

and update policies as appropriate. Member contracts differ in their benefits. Always consult the member benefit

booklet or contact a member service representative to determine coverage for a specific medical service or supply.

CPT codes, descriptions and materials are copyrighted by the American Medical Association (AMA). ©2020 Premera

All Rights Reserved.

Scope: Medical policies are systematically developed guidelines that serve as a resource for Company staff when

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Washington. ອາດຈະມີ ນທີ າຄັນໃນແຈ້ງການນ້ີ . ທ່ານອາດຈະຈໍ າເປັ ນຕ້ອງດໍ າ ເນີ ນການຕາມກໍ ານົດເວລາສະເພາະເພື່ ອຮັກສາຄວາມຄຸ້ມຄອງປະກັນສຸຂະພາບ ຫຼື ຄວາມຊ່ວຍເຫຼື ອເລ່ື ອງຄ່າໃຊ້ າຍຂອງທ່ານໄວ້ . ທ່ານມີ ດໄດ້ ບຂໍ້ ນນ້ີ ແລະ ຄວາມ ວຍເຫຼື ອເປັ ນພາສາຂອງທ່ານໂດຍບໍ່ ເສຍຄ່າ. ໃຫ້ໂທຫາ 800-592-6804

(TTY: 800-842-5357).

ភាសាែខមរ (Khmer):

ມູ ຮັ ສິ

ມູ ຂໍ້

ສໍ

ຈ່

ວັ

ມູ ຂໍ້ ມີ ໝັ

ຊ່

Română (Romanian): Prezenta notificare conține informații importante. Această notificare poate conține informații importante privind cererea sau acoperirea asigurării dumneavoastre de sănătate prin LifeWise Health Plan of Washington. Pot exista date cheie în această notificare. Este posibil să fie nevoie să acționați până la anumite termene limită pentru a vă menține acoperirea asigurării de sănătate sau asistența privitoare la costuri. Aveți dreptul de a obține gratuit aceste informații și ajutor în limba dumneavoastră. Sunați la 800-592-6804 (TTY: 800-842-5357).

Pусский (Russian): Настоящее уведомление содержит важную информацию. Это уведомление может содержать важную информацию о вашем заявлении или страховом покрытии через LifeWise Health Plan of Washington. В настоящем уведомлении могут быть указаны ключевые даты. Вам, возможно, потребуется принять меры к определенным предельным срокам для сохранения страхового покрытия или помощи с расходами. Вы имеете право на бесплатное получение этой информации и помощь на вашем языке. Звоните по телефону 800-592-6804 (TTY: 800-842-5357).

Fa’asamoa (Samoan): Atonu ua iai i lenei fa’asilasilaga ni fa’amatalaga e sili ona taua e tatau ona e malamalama i ai. O lenei fa’asilasilaga o se fesoasoani e fa’amatala atili i ai i le tulaga o le polokalame, LifeWise Health Plan of Washington, ua e tau fia maua atu i ai. Fa’amolemole, ia e iloilo fa’alelei i aso fa’apitoa olo’o iai i lenei fa’asilasilaga taua. Masalo o le’a iai ni feau e tatau ona e faia ao le’i aulia le aso ua ta’ua i lenei fa’asilasilaga ina ia e iai pea ma maua fesoasoani mai ai i le polokalame a le Malo olo’o e iai i ai. Olo’o iai iate oe le aia tatau e maua atu i lenei fa’asilasilaga ma lenei fa’matalaga i legagana e te malamalama i ai aunoa ma se togiga tupe. Vili atu i le telefoni 800-592-6804 (TTY: 800-842-5357).

Español (Spanish): Este Aviso contiene información importante. Es posible que este aviso contenga información importante acerca de su solicitud o cobertura a través de LifeWise Health Plan of Washington. Es posible que haya fechas clave en este aviso. Es posible que deba tomar alguna medida antes de

េសចកតជី ូ នដំ ងេនះមានព័ ី

ជាមានព័ ៌ ៉ ងសំ ់អពី ់ ៉ ប់ តមានយា ខាន ំ ទរមងែបបបទ ឬការរា

ជូ ត៌ ណឹ នដ

រងរបស់អន

LifeWise Health Plan of Washington ។ របែហលជាមាន កាលបរ ិ ឆ ំ ់ េចទសខានេនៅ

មានយ៉ា ំ ់ ត ងសខាន។ េសចក ំណឹងេនះរបែហល

កតាមរយៈ

ងេសចកត ី នដណងេនះ។ អករបែហលជារតវការបេញញសមតភាព ដល់ ណត់ ំ ឹ ន ូ ច ថ កំ ជូ កន ុ determinadas fechas para mantener su cobertura médica o ayuda con los អន ៃថងជាកចបាសនានា េដ ី ឹ ុ ៉ ប់ ុខភាពរបស់ ក ឬរបាក់ costos. Usted tiene derecho a recibir esta información y ayuda en su idioma ់ ់ ើមបនងរកសាទកការធានារា រងស

ក sin costo alguno. Llame al 800-592-6804 (TTY: 800-842-5357). ជ ំ យេចញៃថ កមានសិ េដាយមិ ុ ើ ូ ូ នអសលយេឡយ។ សមទ

ទធ នួ ល។ អន នួ ិ ួលព័ ៌ ិងជំ ន ុងភាសារបស ទទ តមានេនះ ន យេនៅក អន ់

800-592-6804 (TTY: 800-842-5357)។

រស័

ਅੰ

ਜਾਬੀ (Punjabi): paunawa na ito ay maaaring naglalaman ng mahalagang impormasyon ਇਸ ਨੋ ਿਟਸ ਿਵਚ ਖਾਸ ਜਾਣਕਾਰੀ ਹੈ. ਇਸ ਨੋ ਿਟਸ ਿਵਚ LifeWise Health Plan of tungkol sa iyong aplikasyon o pagsakop sa pamamagitan ng LifeWise

Health Plan of Washington. Maaaring may mga mahalagang petsa dito sa Washington ਵਲ ਤੁ ਜ ਅਤੇ ਅਰਜੀ ਬਾਰੇ ਮਹਤਵਪੂ ੋ ਸਕਦੀ ਹਾਡੀ ਕਵਰੇ ੱ ਰਨ ਜਾਣਕਾਰੀ ਹ

ពទ

paunawa. Maaring mangailangan ka na magsagawa ng hakbang sa ilang ਹੈ ੋ ਿਜਸ ਜਵਚ ਖਾਸ ਤਾਰੀਖਾ ਹੋ ਂ ਹਨ. ਜੇ ੁ ੇ ੱ ਖਣੀ ਹੋ ੇ mga itinakdang panahon upang mapanatili ang iyong pagsakop sa . ਇਸ ਨ ਸਕਦੀਆ ਕਰ ਤਸੀ ਜਸਹਤ ਕਵਰਜ ਿਰ ਵ ਜਾ ਓਸ ਦੀ ਲਾਗਤ ਜਿਵੱਚ ਮਦਦ ਦੇ ੱ ੁ ੋ ਤਾਂ ਤੁ ੰ ੂ ਤਮ ਤਾਰੀਖ਼ ਤ ਪਿਹਲਾਂ ਕੁ kalusugan o tulong na walang gastos. May karapatan ka na makakuha ng ਇਛਕ ਹ ਹਾਨ ੱ ਝ ਖਾਸ

ganitong impormasyon at tulong sa iyong wika ng walang gastos. Tumawag ਕਦਮ ਚੁਕਣ ਦੀ ਲੜ ਹੋ ਸਕਦੀ ਹ ੈ,ਤੁ ੰ ੂ ਮੁ ੱ ਚ ਤੇ ੱ ਚ ਜਾਣਕਾਰੀ ਅਤੇ ੱ ੋ ਹਾਨ ਫ਼ਤ ਿਵ ਆਪਣੀ ਭਾਸ਼ਾ ਿਵ ਮਦਦ sa 800-592-6804 (TTY: 800-842-5357). ਪ੍ਰ ੈਾਪਤ ਕਰਨ ਦਾ ਅਿਧਕਾਰ ਹ ,ਕਾਲ 800-592-6804 (TTY: 800-842-5357).

ਪੰ

Tagalog (Tagalog): Ang Paunawa na ito ay naglalaman ng mahalagang impormasyon. Ang

ไทย (Thai): ประกาศน ้ีมีข้อมลูสําคญั ประกาศน ้ีอาจมีข้อมลูที่สําคญัเกี่ยวกบัการการสมคัรหรือขอบเขตประกนั

(Farsi): فارسی فرم بارهدر ھمم اطالعات حاوی است ممکن يهمالعا اين . ميباشد ھمم اطالعات یوحا يهمالعا اين

สขุภาพของคณุผ่าน LifeWise Health Plan of Washington และอาจมีกําหนดการในประกาศ طريق از ماش ای مهبي وششپ يا و تقاضا LifeWise Health Plan of Washington به .باشدี น جهتو يهمالعا اين در ھمم ھای خيتار يا تان بيمه وششپ حقظ برای است کنمم ماش . يدماين کمک คณุอาจจะต้องดําเนินการภายในกําหนดระยะเวลาที่แน่นอนเพื่อจะรักษาการประกนัสขุภาพของคณุ

اجتياح صیاخ کارھای امانج برای صیمشخ ھای خيتار به تان، انیمدر ھای زينهھ پرداخت درหรือการช่วยเหลือที่มีค่าใช้จ่าย คณุมีสิทธิที่จะได้รับข้อมลูและความช่วยเหลือน ้ีในภาษาของคณุโดยไม่ม ีباشيد داشته . رايگان ورط به ودخ انزب به را مکک و اطالعات اين که داريد را اين حق ماش

(ค่าใช้จ่าย โทร 800-592-6804 (TTY: 800-842-5357 مارهش با اطالعات سبک برای . نماييد دريافت 800-592-6804 . اييد نم برقرار استم ) 5357-842-800 مارهباش اس تم TTY کاربران(

Polskie (Polish): To ogłoszenie może zawierać ważne informacje. To ogłoszenie może zawierać ważne informacje odnośnie Państwa wniosku lub zakresu świadczeń poprzez LifeWise Health Plan of Washington. Prosimy zwrócic uwagę na kluczowe daty, które mogą być zawarte w tym ogłoszeniu aby nie przekroczyć terminów w przypadku utrzymania polisy ubezpieczeniowej lub pomocy związanej z kosztami. Macie Państwo prawo do bezpłatnej informacji we własnym języku. Zadzwońcie pod 800-592-6804 (TTY: 800-842-5357).

Português (Portuguese): Este aviso contém informações importantes. Este aviso poderá conter informações importantes a respeito de sua aplicação ou cobertura por meio do LifeWise Health Plan of Washington. Poderão existir datas importantes neste aviso. Talvez seja necessário que você tome providências dentro de determinados prazos para manter sua cobertura de saúde ou ajuda de custos. Você tem o direito de obter esta informação e ajuda em seu idioma e sem custos. Ligue para 800-592-6804 (TTY: 800-842-5357).

Український (Ukrainian): Це повідомлення містить важливу інформацію. Це повідомлення може містити важливу інформацію про Ваше звернення щодо страхувального покриття через LifeWise Health Plan of Washington. Зверніть увагу на ключові дати, які можуть бути вказані у цьому повідомленні. Існує імовірність того, що Вам треба буде здійснити певні кроки у конкретні кінцеві строки для того, щоб зберегти Ваше медичне страхування або отримати фінансову допомогу. У Вас є право на отримання цієї інформації та допомоги безкоштовно на Вашій рідній мові. Дзвоніть за номером телефону 800-592-6804 (TTY: 800-842-5357).

Tiếng Việt (Vietnamese): Thông báo này cung cấp thông tin quan trọng. Thông báo này có thông tin quan trọng về đơn xin tham gia hoặc hợp đồng bảo hiểm của quý vị qua chương trình LifeWise Health Plan of Washington. Xin xem ngày quan trọng trong thông báo này. Quý vị có thể phải thực hiện theo thông báo đúng trong thời hạn để duy trì bảo hiểm sức khỏe hoặc được trợ giúp thêm về chi phí. Quý vị có quyền được biết thông tin này và được trợ giúp bằng ngôn ngữ của mình miễn phí. Xin gọi số 800-592-6804 (TTY: 800-842-5357).