EASE: Expanding Access to an Innovative Sleep Apnea Procedure

CompanyBackground

Cooler Heads is a rapidly growing medical device company transforming access to scalp cooling therapy, an innovative solution designed to reduce chemotherapy-induced hairloss. With a CPT Category III code and an anticipated transition to a permanentCategory I code in 2026, the company is scaling quickly and building out itsreimbursement and patient access infrastructure from the ground up.

The Challenge

As Cooler Heads expanded, it faced an urgent need to develop a streamlined reimbursement process for patients, many of whom were unfamiliar with navigating prior authorizations and insurance appeals. Without an established internal patient access team or defined process, Cooler Heads was in search of a partner to support their growing reimbursement needs.

Why They Chose Paxos

Cooler Heads selected Paxos based on deep trust in the team’s prior experience in the medical technology space. Paxos also demonstrated a flexible, collaborative approach and an understanding of what both patients and providers needed when navigating access to the Cooler Heads product. The ability to build a custom patient-facing portal, incorporate evolving payer policies, and adapt as new provider-facing tools became necessary, made Paxos the ideal partner.

"As someone who has navigated the complexities of the healthcare system for years, I can confidently say that Paxos has been a game-changer. What used to feel like a frustrating, confusing process—waiting weeks for approvals, endless calls, paperwork—has now become fast, clear, and empowering. For the first time, I felt like a real partner in my own care journey. Paxos didn’t just improve the process; they made me feel seen, heard, and respected. That means everything.
Sarah M
CEO

Because we configure our platform to each client’s needs, the use-case for each client can vary. Some other examples of our use-cases include:

  • Using AI to assess a patient’s case for prior auth and appeal submission-readiness, and automatically generating customized prior auth and appeal letters

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  • Setting up the patient access program for Cooler Heads

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  • Directly helping patients overturn health insurance denials

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These are just a few potential use-cases, our tool can be used by patient access teams, providers, and/or patients. We build the platform to your specific needs.

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Company Background

Providers at the Sleep Apnea Surgery Center in Palo Alto, CA perform a highly specialized maxillofacial technique, Endoscopically-Assisted Surgical Expansion (EASE). The outpatient procedure addresses obstructive sleep apnea (OSA) by widening the nasomaxillary complex using a minimally invasive, endoscopic osteotomy and transpalatal distractor. Multiple peer-reviewed studies report significant improvements in airway metrics, including reductions in AHI and nasal airflow resistance, yet patients were struggling to access it due to payer denials (sometimes labeling the treatment as “experimental”), or issues involving lack of in-network benefits. The provider’s administrative support is lean, with limited capacity for multiple rounds of time-intensive appeals and custom medical necessity documentation.

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The Challenge

  • Limited Administrative Bandwidth: The provider’s small support team was committed to patient care but lacked bandwidth to assist with all complex documentation needed for individualized appeals.

  • Payer Challenges: Several payers were denying EASE for a number of reasons, including labelling it as investigational or not medically necessary.

  • Network Gaps: Patients often faced out-of-network risk or insufficient in-network coverage, further complicating access.

03

Why They Chose Paxos

Alex and Malcolm brought proven expertise in maxillofacial reimbursement. Paxos understands the nuances of EASE and how to create tailored, anatomically precise appeal letters rooted in clinical rationale. In other words, Paxos was able to build a customized, patient-facing advocacy pathway.

Our Solution

Synthesizes medical information with AI to generate prior auths, appeals, and other patient-specific documents
Transforms your team into case reviewers rather than writers by enabling AI-assisted double-checking of all outputs
Integrates payer-specific policies, diagnosis-specific guidelines, clinical literature, and product evidence
Delivers up-to-date reimbursement trend data for your device to support payer negotiations and provider sales

How Paxos Helped

Paxos partnered directly with the provider’s practice and patients to streamline access through several coordinated interventions:

01

Reduced operations costs

We streamline reimbursement workflows and empower your case writers to become case reviewers who can focus their expertise on the things that matter, not cumbersome documentation tasks.

Increased product adoption

We aim to drive higher payer approvals and broader coverage, building provider confidence to utilize your innovative technology.

02

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Enhanced reimbursement insights

Our data equips patient access teams to better navigate payer negotiations and improve their provider sales process.

Patient Advocacy & Point-of-Care Support
Paxos engaged patients personally, helping collect documentation, guiding them through the appeal process, and submitting insurance appeals directly to payers, including for employer plans and out-of-network coverage.
Customized Appeal
Letters
The team generated medical necessity and non-experimental appeals, tailored to patient-specific arguments and insurance policies.
Network Gap Appeals
Paxos crafted appeals targeted at securing in-network benefit waivers, reducing patients’ financial burden.
Positive Outcomes
Over the pilot, Paxos supported many patients who received full or partial approval for coverage, lifting major barriers. More patients accessed the specialized treatment due to reduced billing hassle.

Paxos not only enabled the Sleep Apnea Surgery Center to extend access to this innovative procedure; they laid the groundwork for broader payer acceptance by demonstrating therapeutic and financial value. 

Testimonials

Paxos' expertise and tailored reimbursement tools are streamlining our ability to get devices to patients, producing reliable and policy-focused documents without requiring us to hire additional staff. Their offering is also increasing utilization of our product with payers, which will help with achieving broader payer coverage.

Interested in our solution?

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