compliance and insurance

[sleepyinmississippi]

Hello.
I'd like to know if insurance companies withhold payment if you buy another CPAP (when you're old one dies of old age, that is) if they see your CPAP compliance reports?
Do they get access to your CPAP digital compliance reports?
I ask because many nights, I only sleep 5 or 6 hours--all of that time with CPAP mask on--but I don't need 8 hours sleep (I'm 45) anymore, now that I'm on CPAP.
Also, I don't wear the CPAP mask when I get a cold and am congested (as I assume is the case with most people).
Still--how difficult is it for one to get a replacement CPAP if one has a seemingly non-complaint CPAP report?
BTW, I just got my CPAP in May 2012; and hopefully it'll last a long time (and yes, I'm using it!) But I find it unnerving that there's a digital trail of my CPAP compliance, as I use it 99% of the time.

Thanks,

Sleepyinmississippi

[BlackSpinner]

Compliance is required by the DME for the first 3 months - you need 4 hours on 70% of the nights otherwise the insurance company doesn't pay them. After that they don't care. Some might care when you need a new machine but again 4 hours 70%.

[jdm2857]

I believe that this is the current Medicare standard for CPAP compliance. Many insurance companies follow the rules that Medicare creates.

A data report from your sleep equipment which documents that the PAP has been used for at least 4 hours per night on 70% of nights during a 30-day consecutive period is required.

The 30-day period must occur during the first 90 days of CPAP use.

The 4 hours per night requirement should allay your fears.

Edit: I see I was out-spinned.

[sleepyinmississippi]

To Blackspinner and JDM,
Thanks for your posts!

[4betterO2]

Hello.
I'd like to know if insurance companies withhold payment if you buy another CPAP (when you're old one dies of old age, that is) if they see your CPAP compliance reports? I just got my CPAP in May 2012

it's a bit confusing; the CPAP you got in May 2012 is your new one? if so, you're way past the compliance period, no worry.
It's not the one dying out, right?
Btw the requirements shown on the Respironics website indicates 30 days @ 70% >=4hs for CPAP and BIPAP, but 61 days @ 70% >=4hs in the case of an ASV.
I believe though that to keep covering the regular maintenance of peripherals (mask, headgear, humidifier tank, tube), insurance requires at least a yearly visit with a specialist/sleep doctor, but I don't think they then look at the SD card data.
Only professional drivers, pilots, etc., need to worry about continuous medical surveillance,-- for other reasons than insurance.

[archangle]

Insurance is like having a wife or a girlfriend. If you think you can predict what she's going to go psycho on you, you're deluding yourself. (or swap the gender on the above statement if you're female.) It can vary from company to company, time to time, or on the whim of which particular person you're dealing with at the company.

However, technical "compliance" requirements usually goes away after a short time for insurance. Especially after you finish your "rental" period and are no longer paying a monthly charge.

I've never heard of a compliance check before getting a replacement machine. However, insurance is getting a lot more picky about providing replacement machines these days.