Going to be needing knee surgery soon... might lose my CPAP

[pettyfan45]

Hi all, it has been a while. So it seems I dislocated my knee cap (long story short on that: be careful getting out of the shower kids ) and will need surgery to fix it. I am concerned that insurance might stop paying for my CPAP if I get admitted for a few days and the hospital won't let me use my own machine there. (I am ware this surgery is usually out patient, but I have cerebral palsy and though I can walk I have stability issues with both legs that might make it difficult to use crutches and my house is a bit to small to get around on a wheel chair). My insurance dose the one year rental thing where after they make the 13th payment then it is mine, but I have only had my machine for 6 months and though I am past the normal compliance window I am not sure if the insurance company is still monitoring that (or my DME is and if I don't use it for X amount of days they have to inform the insurance company). Do insurance companies have to exception for this type of thing if you are admitted to a hospital or will have to choose between getting my knee fixed now, possibly lose my machine, have to start the process all over or live with the pain in my knee for 6 more months till my machine is paid off?

[LSAT]

If you have had your machine for 6 months, the compliance period is probably over. Compliance is required by the DME/insurance for the first 3 months - you need 4 hours or more on 70% of the nights, otherwise the insurance company doesn't pay. After that they don't care.

[chunkyfrog]

If the worst happens anyway, CALL A LAWYER.
Once the poop contacts the fan, heads will roll.

[palerider]

Just use your machine, don't ask.

[ChicagoGranny]

I am concerned that insurance might stop paying for my CPAP if I get admitted for a few days and the hospital won't let me use my own machine there.

Most insurance companies follow the Medicare rules, which are:

Objective evidence of adherence to use
(defined as use of PAP devices for 4 or more
hours per night on 70% of nights during a
consecutive 30-day period anytime during
the first 3 months of initial use) of the PAP
device, reviewed by the treating physician.

I'm with PR on this. Just keep using the device after you are back home and never bring up the hospital stay.

[Guest]

Just use your machine, don't ask.

I doubt anyone will tell you that you can't use it.
But how bout telling what your compliance is like now?
How many hours a day?
Who is your insurance?
How long do you think you will be in the hospital?
If you are adjusted to the cpap you will sleep (and heal) much better with the cpap.

[pettyfan45]

I am concerned that insurance might stop paying for my CPAP if I get admitted for a few days and the hospital won't let me use my own machine there.

Most insurance companies follow the Medicare rules, which are:

Objective evidence of adherence to use
(defined as use of PAP devices for 4 or more
hours per night on 70% of nights during a
consecutive 30-day period anytime during
the first 3 months of initial use) of the PAP
device, reviewed by the treating physician.

I'm with PR on this. Just keep using the device after you are back home and never bring up the hospital stay.

The thing is they will know about the hospital stay because they will be paying for it

[grizzlybearclark]

every time i have had surgery they wanted me to bring my own apap machine. it makes sense its already setup for what you need.

[robysue]

pettyfan45,

If you have good usage for the past 6 months, it should not be an issue.

Since you are worried about it, I would suggest that you contact the insurance company and ask to speak to a patient case manager or some such person. Tell them what you've told us: You got the CPAP roughly 6 months ago, you got through the early compliance checks without any problem, and the insurance company has been paying monthly rent-to-own payments since you got the machine. And tell them you will be undergoing an inpatient surgery in a hospital and you may not have access to your personal CPAP while you are in the hospital, but that you intend on continuing to use your machine as soon as you get back home. And ask for reassurance that the hospital stay will not mess up the rent-to-own payments on the CPAP.

[mrbreezeet1]

I am concerned that insurance might stop paying for my CPAP if I get admitted for a few days and the hospital won't let me use my own machine there.

Most insurance companies follow the Medicare rules, which are:

Objective evidence of adherence to use
(defined as use of PAP devices for 4 or more
hours per night on 70% of nights during a
consecutive 30-day period anytime during
the first 3 months of initial use) of the PAP
device, reviewed by the treating physician.

I'm with PR on this. Just keep using the device after you are back home and never bring up the hospital stay.

The thing is they will know about the hospital stay because they will be paying for it

That's true, did the hospital say you won't be allowed to use it?

Sent from my MotoG3 using Tapatalk

[mrbreezeet1]

pettyfan45,

If you have good usage for the past 6 months, it should not be an issue.

Since you are worried about it, I would suggest that you contact the insurance company and ask to speak to a patient case manager or some such person. Tell them what you've told us: You got the CPAP roughly 6 months ago, you got through the early compliance checks without any problem, and the insurance company has been paying monthly rent-to-own payments since you got the machine. And tell them you will be undergoing an inpatient surgery in a hospital and you may not have access to your personal CPAP while you are in the hospital, but that you intend on continuing to use your machine as soon as you get back home. And ask for reassurance that the hospital stay will not mess up the rent-to-own payments on the CPAP.

Plus one.
That sounds like a good idea.

Sent from my MotoG3 using Tapatalk

[pettyfan45]

Just use your machine, don't ask.

I doubt anyone will tell you that you can't use it.
But how bout telling what your compliance is like now?
How many hours a day?
Who is your insurance?
How long do you think you will be in the hospital?
If you are adjusted to the cpap you will sleep (and heal) much better with the cpap.

The thing is sometimes Hospitals would rather you not bring your own CPAP from and instead use theirs, the biggest reason being they don't want to be responsible should the machine get damaged (also so they can charge the insurance more).
My Compliance has been damn near prefect since I got my machine, the only night I got less than 4 hours was because of a power outage in the middle of the night.
8-9 hours a day
Insurance is MO Health Net (Medicaid)
I have no clue on how long I could be in the hospital, they could just keep me overnight they could keep me a week or more I have no clue.
If they don't let me use my CPAP then I will most likely be using a hospital machine.

[chunkyfrog]

Play the "cerebral palsy card"--MAKE the hospital do it YOUR way.
It is likely they are more afraid of you and your condition than you could be of their bureaucracy.

[Wulfman...]

Tell the hospital that you HAVE to use YOUR machine for compliance purposes. It's non-negotiable.
I really don't foresee a problem if you're upfront with them. It's YOUR machine and it's already set-up with YOUR settings.

If they still balk at that, make up a form that they would have to fill out with the specific make/model of machine you would be using, the hours used (from the two meters on their machine) and tell them that you will want it signed by their Respiratory Therapists and notarized upon your leaving the hospital. Maybe they would have second thoughts at all the extra work they would have to do to comply with your demands.
Also, they're also being paid by YOUR insurance and YOU and essentially they work for YOU. "The customer is always right!"


Den

.

[palerider]

I'm with PR on this. Just keep using the device after you are back home and never bring up the hospital stay.

actually, it was "take your machine to the hospital and use it, don't ask, just tell them".