What is compliant??

carbonman · Post by **carbonman** » Fri Jul 04, 2008 7:52 pm

What does it mean to be compliant w/your CPAP??

Are there CPAP police out there??
No one told me about this.

Am I missing something I should know?

Thanks!

yorkiemum01 · Post by **yorkiemum01** » Fri Jul 04, 2008 8:08 pm

using as directed.........whenever you're sleeping ..simply in my opinion.

Wulfman · Post by **Wulfman** » Fri Jul 04, 2008 8:11 pm

It all depends on if your insurance provider has requirements for payment to your DME.
However, according to most machine defaults (for counting), the minimum number of hours per night is FOUR.
I've also seen a 70% figure associated with some of the insurance providers.

So, 4 or more hours per day/night for 70% of the time. (unless your insurance provider have a higher criteria)

Most of us try to keep much higher standards than that.

Den

clancy2 · Post by **clancy2** » Fri Jul 04, 2008 8:14 pm

I find this an interesting question.

I try to use it all the time but once in a while I wake up with it off will the insurance company find out and charge me for that.

carbonman · Post by **carbonman** » Fri Jul 04, 2008 8:21 pm

Wulfman wrote:It all depends on if your insurance provider has requirements for payment to your DME.

Den

Should my DME or my insc. comp. given me this info/requirement
when I got my machine???

If you don't meet their requirements, do they drop the coverage...

because they figure you're a slakker??

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GumbyCT · Post by **GumbyCT** » Fri Jul 04, 2008 8:21 pm

The Ins. Co. could find out yes. But it would be the DME billing YOU when the Ins. doesn't pay bc you were NOT compliant, ha!

So yea it really could cost ya - in more ways than one.

carbonman · Post by **carbonman** » Fri Jul 04, 2008 8:24 pm

clancy2 wrote:newbie Hosehead, can use all the advice you can give.

clancy2, me too.

carbonman · Post by **carbonman** » Fri Jul 04, 2008 8:29 pm

GumbyCT wrote:The Ins. Co. could find out yes. But it would be the DME billing YOU when the Ins. doesn't pay bc you were NOT compliant, ha!

........so.......is the insc. going to show up at my door one day,
with torches and axes,
demanding to see my machine stats???

Wulfman · Post by **Wulfman** » Fri Jul 04, 2008 8:37 pm

carbonman wrote:
Wulfman wrote:It all depends on if your insurance provider has requirements for payment to your DME.

Den
Should my DME or my insc. comp. given me this info/requirement
when I got my machine???

If you don't meet their requirements, do they drop the coverage...

because they figure you're a slakker??

They SHOULD have. It may be in your contract with your DME......if they gave you one, you probably need to read it.
I can't speak from experience as I purchased all of my equipment out-of-pocket and then my insurance provider reimbursed me......in effect, there were no contracts that I had to comply with. But, I have taken the compliance thing very seriously.
There could be other legal implications if a person was not compliant and then (for example) had a vehicle accident......that could put you in the "hot seat" for not using your therapy as prescribed. There have been numerous discussions on the forums about that and quite a few news reports of vehicle accidents where people were not compliant and somebody was either killed or seriously injured. This is another reason why I have data-capable machines and save ALL of my Encore and related reports......I can PROVE my compliance and the effectiveness of my therapy.

Den

Wulfman · Post by **Wulfman** » Fri Jul 04, 2008 8:41 pm

carbonman wrote:
GumbyCT wrote:The Ins. Co. could find out yes. But it would be the DME billing YOU when the Ins. doesn't pay bc you were NOT compliant, ha!

........so.......is the insc. going to show up at my door one day,
with torches and axes,
demanding to see my machine stats???

The insurance provider probably won't, but if your insurance payment criteria to your DME is dependent on your compliance, they COULD stop making payments to the DME and then YOU would be responsible for whatever balance would remain.

The DMEs are usually the ones responsible for determining whether you're meeting your compliance criteria.

Den

jules · Post by **jules** » Fri Jul 04, 2008 8:47 pm

To charge from "rental" to "purchase" I was required to have a letter from my doctor indicating compliance. The DME never read my card or looked at my data on my machine. My doctor had copies of my encore pro results and he wrote his letter based on that.

I had asked the DME about reading the card early on. If I had been on medicaid or other state funded insurance (there is another program here in WA people can buy I understand), the DME would have been reading my card frequently, and reporting the compliance information up the line.

wlo2008 · Post by **wlo2008** » Sat Jul 05, 2008 12:20 am

the state pays for my machine to as well. So they DME will be checking my smart card a lot considering how much they pay for the machine. I have a higher end machine. But I feel that we all should be willing to be compliant sense it means our life.

I was not alowed to drive till I was well in to threaphy. But I was also falling a sleep all the time at the wheel of my car. Much like someone drinking and driving or other medical conditions that prevent you from driving if I killed someone do to not being compliant to theaphy then I would have to pay the price.

Also I have had two uncles die from SA complications. One from Congestive Heart failure caused my SA. He got treatment to late. The other was a firefighter and died during training with all his equipment on because SA will effect your lungs as well.

So why not be compliant even if it is tuff? I always have felt if you go in with a bad additude with the Cpap you will not be compliant. But if you look at the possitives you will end up thanking the Cpap for saving your life.

carbonman · Post by **carbonman** » Sat Jul 05, 2008 7:26 am

Wulfman wrote:
Most of us try to keep much higher standards than that.

Den

Thanks everyone for the info/insights.
I checked all my paper work from DME and there are only some general
guidelines, nothing specific about compliance.

So far, I don't see a problem w/compliance,

I want my life back.

Wulfman · Post by **Wulfman** » Sat Jul 05, 2008 10:04 am

Some of the entities (read doctors, insurance or DMEs) usually allow some "wiggle room" with people who are diligently TRYING to be compliant and appear to be making an effort to get their therapy working.

The obstacles in the road to compliance that many of the patients have to deal with are: Cheapest, non-data-recording machines; cheapest, improperly fitted masks; wrongly prescribed pressures from titration; little or no information/instruction from DMEs and (although I'm sure there are many more) lack of follow-up contact/support.......unless they're lucky enough to find THIS forum (or have one of the great DMEs or RTs that frequent this forum) .

Den

Wulfman · Post by **Wulfman** » Sat Jul 05, 2008 10:09 am

carbonman wrote:
Wulfman wrote:
Most of us try to keep much higher standards than that.

Den
Thanks everyone for the info/insights.
I checked all my paper work from DME and there are only some general
guidelines, nothing specific about compliance.

So far, I don't see a problem w/compliance,

I want my life back.

Patience....... and "Baby steps"

You didn't get to where you were, overnight......you won't reverse the detrimental effects overnight, either.

Been there.......and most of the rest of those on the forum would say that, too.

Hang in there.

Den

Mask