Question for people being monitored by insurance

[SleepGeek]

So I think their plan all along was to wait the compliance period (13 months) and they thought they could get more than Medicare would pay them for the same device.

You are confusing the compliance period with the capped rental period. The compliance period for Medicare is 90 days--you must use your CPAP at least 4 hours per night for 70% of nights (that’s 21 nights) during a consecutive 30 day period any time in the first three months of initial usage.

The capped rental period is 13 months.

You are right but IMHO they had no interest in compliance at all. I shouldn't have added any numbers.

Actually, I believe back then compliance was >4hrs use for 21 consecutive days out of the first 90.

They were interested in more money. If they were interested in compliance they would have contacted me by phone or by US Mail - neither was done.

[Sasquatchswapgator]

They want me to use the my air app. ... Keeps showing no data.

If you are looking for data first thing in the morning, it won't be there. The data is transmitted later in the day.

If you see no data for earlier days, there might be a problem. Do you have Airplane mode turned on? Do you have cell service in your bedroom?

My cell service is hit and miss. No I don’t have airplane mode turned on. I thought about it. We barely have WiFi. Only gotten WiFi a couple years ago when it came here.

[Sasquatchswapgator]

I was told by the DME if I get into the clinical settings it would void the insurance paying for it. Didn’t think that was true but had to ask.

In case you didn't know....DMEs will lie when the truth would fit better.

Insurance companies don't care (don't even know) what your settings are or the results or leaks or even if therapy is optimal.
All they want to know is that you are using the machine the minimal required number of hours.

And just in case you are told the big lie "it's against the law for the patient to change anything"....ask them to prove it in writing and show the documentation and the law. There is no such law. Patients can do whatever they want.
Now the DME...they can't change anything without a doctor's okay but the patient isn't under the same restrictions.

Someone gave you the Medicare requirements....if you don't have Medicare call up your insurance company and ask them what their requirements are.
Don't ever accept what the DME tells you without verifying it yourself with your insurance company.

I do not have Medicare. From talking to my insurance they said talk to your dr we just want you to use it for the 4 hrs. The DME was like insurance will know if you change it. I’m like how? What is it hurting you?

[Sasquatchswapgator]

For some reason the DME's worry about us changing our settings not the insurance or even the doc prob doesn't. The DME also worries about hours of use so they can get paid. So you can disconnect the modem to see if the DME is watching but as long as the hours are on the machine you can prove it.

I took my modem right out and Apria tried to get me to pay them more than the insurance price but in court I proved I was using it more than 8hrs/day with my OSCAR reports and notes from my doc. Apria never contacted me to get any data.

The modems used to be a separate item that plugged into your CPAP machine, but now they are integral to the latest models. So there's no way to "take it right out". But you can put it in airplane mode so that it will not send the information to your DME.

However, during the compliance period, you probably do not want to do that, because then you either have to turn over your SD card to them so that they can read the compliance data to report it to your insurer, OR they are going to want you to bring your machine in to them for the same, so that they can document compliance and get paid. DME's kind of like getting paid, and if the insurer refuses because compliance can't be documented, you can bet the DME will expect YOU to pay.

Once your compliance period is over, it's none of their business. My machine has been in airplane mode since the day it was paid for (in my case, there was no compliance period, so it was the day I got it).

I can't imagine ANYBODY going to court over this--ridiculous! The time and expense and stress are hardly worth the effort--it would have been easy enough to transfer the data to an SD card for Crapria to read--that's how they did it before modems were common.

Note that if you change the settings and the DME happens to notice while documenting the settings, it's possible (though unlikely) they could change them back. If you feel like your therapy is "different", check your settings to make sure they are as you set them.

I thought about putting it in airplane mode. I will as soon as the 3 months are done. I will keep checking throughout these months to make sure things stay the same. I just didn’t like the DME having a threatening tone over the situation. Either way the cpap with be used.

[Cecioboe]

Insurance doesn't care about your settings....they just want you to be using the machine they paid for.

"Thank you. I was told by the DME if I get into the clinical settings it would void the insurance paying for it. Didn’t think that was true but had to ask. "

They just don't want you to change anything. I asked my DME how I could get more data and he said through the clinical settings. He was very reluctant to tell me how to get there (I already knew because I researched it) but did when I promised I wouldn't change the settings. I also got an SD card and monitor my info on OSCAR.

[Dog Slobber]

The modems used to be a separate item that plugged into your CPAP machine, but now they are integral to the latest models. So there's no way to "take it right out". But you can put it in airplane mode so that it will not send the information to your DME.

Check this video, in <5sec its in airplane mode, no buttons to push, no screws to remove, no problem. I saved mine in case I needed it again. https://www.youtube.com/watch?v=yRbOdiHykRA

That video is absolutely ridiculous and does not [necessarily] prevent sending your data to Respironics' servers.

While removing the modem will obviously prevent the device from sending data directly to Respironics. What these guys neglect to tell you or simply don't know, DreamMapper also sends your data to Respironics' servers.

A lot of people use DreamMapper, download their data from their device via bluetooth, DreamMapper then uploads the data to Respironics.

And don't get me started on how asinine those clowns are telling people how easy it is to change the data files, "I can show you really quick how you at home modify this data". Anybody who is so neglectful in describing how the fields are to be modified, can't be trusted sd being thorough enough to have modified all required fields.

If you have a DreamStation, and don't want to share you data, remove the modem, and do not run DreamMapper.

[SleepGeek]

While removing the modem will obviously prevent the device from sending data directly to Respironics. What these guys neglect to tell you or simply don't know, DreamMapper also sends your data to Respironics' servers.

The point is how easy it is to remove the modem. It apparently worked for me - neither Apria nor my doc could find my data on their accounts. I simply printed out the data to show my doc who always said how impressed she was not only with my usage but my daily AHI avg.

I would never suggest someone who doesn't know what they are doing modify their data - not sure what the point would be unless you simply aren't using the cpap.

[chunkyfrog]

Never put it past a DME to consider/attempt double-billing.
It totally fits the profile . . .

[Janknitz]

They just don't want you to change anything.

I'm not sure who the "they" is you are referring to?

The insurance company doesn't care.
Only a few doctors who really care about helping their apnea patients might occasionally care because they are working hard to optimize treatment for their patients. (These doctors are unicorns).
DME's don't really care because all they are concerned about is getting paid with the efficacy data to prove usage.
The mythical CPAP police are too busy eating mythical donuts to care. (No offense, Sheriff Buford, I know REAL cops don't eat donuts ).

But, whatever . . .

[Okie bipap]

(No offense, Sheriff Buford, I know REAL cops don't eat donuts ).

My son-in-law will not eat a doughnut when he is in uniform. He will only eat them at home when he is off duty.

[SleepGeek]

The modems used to be a separate item that plugged into your CPAP machine, but now they are integral to the latest models. So there's no way to "take it right out". But you can put it in airplane mode so that it will not send the information to your DME.

Check this video, in <5sec its in airplane mode, no buttons to push, no screws to remove, no problem. I saved mine in case I needed it again. https://www.youtube.com/watch?v=yRbOdiHykRA

However, during the compliance period, you probably do not want to do that, because then you either have to turn over your SD card to them so that they can read the compliance data to report it to your insurer, OR they are going to want you to bring your machine in to them for the same, so that they can document compliance and get paid. DME's kind of like getting paid, and if the insurer refuses because compliance can't be documented, you can bet the DME will expect YOU to pay.

Since Apria never notified me of the modem and I did not sign any release I felt free to remove the modem.

For whatever reason Apria never contacted me or even attempted to contact me to get any data or even to see if I was having a problem using it. You're right for my 1st cpap back in the old world they would send someone out to the house to write down the hours and AHI from the screen. They never took a data card for any reason - all they are interested in is Hours of Use.

So I think their plan all along was to wait the compliance period and they thought they could get more than Medicare would pay them for the same device.

Once your compliance period is over, it's none of their business. My machine has been in airplane mode since the day it was paid for (in my case, there was no compliance period, so it was the day I got it).

I can't imagine ANYBODY going to court over this--ridiculous! The time and expense and stress are hardly worth the effort--it would have been easy enough to transfer the data to an SD card for Crapria to read--that's how they did it before modems were common.

Note that if you change the settings and the DME happens to notice while documenting the settings, it's possible (though unlikely) they could change them back. If you feel like your therapy is "different", check your settings to make sure they are as you set them.

Are you defending Apria? It was Apria who took the legal road on this - not I. You can pay them $2200 for a bipap I was not about to.

I contacted the State Health Insurance Assistance Program who helped resolve this saying they have heard of Apria pulling this before.

I don't know anywhere in the Medicare guidelines/rules that says you have to have a modem or that they will pay for a modem. I had all the documentation to prove I used it for 100% of the days in question, not one missed day - the doc had all the data and was paid w/o problem.

When all was said and done I received a document transferring ownership to me. They then had to bill Medicare for the next 13 months - so they got their money just not as much as they wanted or as soon.

When dealing with DME's I give them my insurance and co-pay insurance - never ever a credit card for any reason - and as I recall they did ask but I told them if the code it right and Medicare pays then TFL will pay automatically.

[Sasquatchswapgator]

I have not looked at Oscar but will do so later. Having issues with a dry throat because of my mouth being open. Any way to solve this? The dreamwear full face mask I thought was working and now I’m constantly fiddling with it during the night. The mask makes my face hot and I’ll wake up to it “pooting”. I’m using the humidifier. I know I can probably take the mask back to the DME but I’m not sure yet. The dry throat is what is mainly bothering me.

[GrumpyHere]

I have not looked at Oscar but will do so later. Having issues with a dry throat because of my mouth being open. Any way to solve this? The dreamwear full face mask I thought was working and now I’m constantly fiddling with it during the night. The mask makes my face hot and I’ll wake up to it “pooting”. I’m using the humidifier. I know I can probably take the mask back to the DME but I’m not sure yet. The dry throat is what is mainly bothering me.

viewtopic/t182257/Newbie-struggling-wit ... heeks.html

Or use search box just below the forum banner. Suggested terms: Mouth breathing, scunci, cervical, taping, chin strap.

Gold in them thar hills.

[ChicagoGranny]

I have not looked at Oscar but will do so later. Having issues with a dry throat because of my mouth being open. Any way to solve this? The dreamwear full face mask I thought was working and now I’m constantly fiddling with it during the night. The mask makes my face hot and I’ll wake up to it “pooting”. I’m using the humidifier. I know I can probably take the mask back to the DME but I’m not sure yet. The dry throat is what is mainly bothering me.

The Dreamwear FFM gets very high ratings. Find it on youtube and watch three or four videos on fitting and adjusting.

You might have your humidifier set too warm.

[Sasquatchswapgator]

I have not looked at Oscar but will do so later. Having issues with a dry throat because of my mouth being open. Any way to solve this? The dreamwear full face mask I thought was working and now I’m constantly fiddling with it during the night. The mask makes my face hot and I’ll wake up to it “pooting”. I’m using the humidifier. I know I can probably take the mask back to the DME but I’m not sure yet. The dry throat is what is mainly bothering me.

viewtopic/t182257/Newbie-struggling-wit ... heeks.html

Or use search box just below the forum banner. Suggested terms: Mouth breathing, scunci, cervical, taping, chin strap.

Gold in them thar hills.

I know about the above methods. I thought from what I was told…getting the full face would prevent me from using those. I sleep on my side and stomach. I’ll be watching a video to make sure I have it on right. It’s probably a me thing and not the mask. We’ll see.