Buy your own CPAP How can insurance keep track of compliance

[sapphireskye]

Ok, here is another question. Please forgive for my ignorance. I have Medicare and Medigap...eventually with Blue Cross (3 months) and currently am going through a local DME. If I were to buy my own CPAP from CPAP.COM in the future, how do you then prove to your insurance company your compliance and have them still cover masks, hoses, etc... things that I don't always want to foot the bill for?

Gosh, My brain needs a vacation lol

God bless you all Hoseheads

Chelle

[Mikesus]

Well I don't know what will work for your insurance, but I can tell you what worked for mine. To get reimbursed for my machine, I had to show proof of compliance. The way I did this was through the Encore software. There is a report labeled compliance, and it shows how many nights, and how many hours each night the machine was used. I had no problems getting reimbursed for mine. If I were planning on getting reimbursed, I would make sure that I had a way to provide compliance data to them. (i.e. through a software printout)

[dsm]

In addition to Mikesus comments, most machines list on the readout display the compliance data. This is largely tamper proof.

So just showing them your machine (with original matching serial #) should be quitre adequate.

The data show is typically how many nights the machine has been used for greater than 4 hours plus how many total hours the fan has been running,

The nightly record can be reset to zero (intended to only be reset by a DME but many of us here can do this ourselves) but not a smart thing to do if you want proof of your nightly usage since day 1.

I did reset my data after 1 week but have left it intact since.

Cheers

DSM

[Mikesus]

The problem with that DSM is that there often isn't a place to take the machine to have it looked at. (Normally a DME would state the number of hours used and send that to the insurance provider) I don't think taking a picture of the meter and sending it would work, but you never know. Ask your insurance company to be sure what they will accept as proof of compliance.

[wading thru the muck!]

The problem with that DSM is that there often isn't a place to take the machine to have it looked at. (Normally a DME would state the number of hours used and send that to the insurance provider) I don't think taking a picture of the meter and sending it would work, but you never know. Ask your insurance company to be sure what they will accept as proof of compliance.

Just take your machine into the doc that prescribed it... show him/her the compliance hours.

No need for the DME!

[sapphireskye]

The thing is, I don't care about getting reimbursed for the machine. So, I probably should call my insurance company and find out what is considered proof if the DME is no longer checking up on me. I guess asking if the software information that some of the machines have would be enough. With the type of machine I have now all it shows is compliance, and it is being rented through a local DME. But, if I want to buy one it would be much cheaper to do that online at CPAP.com. I just want to be able to get my mask covered, and to get my mask I will have to go through my local DME anyways. I just don't know if they will give me a hard time once I buy a machine elsewhere.


Well, I guess time will tell
God bless
Chelle

[Mikesus]

Confused... If you aren't trying to get reimbursed, then all you should need is the letter of medical necessity from your doc to be put on file for any further incidentals, i.e. masks etc. Usually the only thing that needs compliance data is when you are trying to get reimbursed for your machine. Dunno about your insurance tho.

And if you take it to your doc, he would have to "certify" your compliance with a letter, my insurance company said that they wanted a report, so that is what I gave them. Best to call them, and see what they require. What my insurance company does and what yours does could be completely different things...

[sapphireskye]

I probably wasn't specific enough, but we are supposed to be getting some money in the next few months, and I felt it would be easier to just purchase a machine and be done with it. I didn't know if you needed the compliance data for the insurance company to still cover the other necessities of the treatment (hoses, masks, etc.). I just don't feel like waiting a whole year to be able to purchase a machine of my choice, and don't feel like dealing with my dme to get a that machine.

God bless
Chelle

[IllinoisRRT]

Hello and Happy New Year everyone... I haven't been around in awhile so I thought I would chime in on this one.

SaphireSkye, is your Medicare primary? If so, their payment schedule (what they will pay 80% of, that is) is as follows:

New mask- every 3 months (headgear they will only pay for every 6, don't get me started!)

Tubing- every month

Pillow device if you have that, one per month

Chinstrap, every 6 months

Ultra fine filter, 2 per month

Washable foam filter, every 6 months.

As far as I know, this is regardless of compliance with your equipment. Medicare used to check compliance regularly, and some other insurances still do. At the DME I work for, we have a contact record that has to be sent to billing after 3 months of therapy. It's basically your word saying that you are using the equipment and will continue to. That's it. Now having said that, I don't know what your secondary (if I'm understanding that correctly) insurance's policies are, but most are in line with what Medicare does. Hope that helps!

[Goofproof]

I got mine from a DME, Remstar Pro 2, The DME had to report to the INS, took my card for 15 days, never were able to download, But I can!

I leave it to them to get paid, You need to ask your ins what they will need.

[sapphireskye]

I guess I probably seem silly that I don't even want to deal with my insurance renting out a machine, but if I can, I just want to buy it straight out and not even worry about submitting it. I have only been on CPAP for three weeks.
I have made my list to take to the doctor when I go. I have Medicare as primary, and Medigap F as secondary which covers everything else so long as it is Medicare approved. But, if hubby stays at his job Blue cross will become primary, medicare secondary, and Medigap third. I have to keep paying Medicare and Medigap because of my very terribly expensive Immunoglobulin treatments I get every three weeks. If I didn't have the other insurance, I would have several thousand in bills each month. Hopefully, this treatment will not have to go more than 6 more months. It is possible I could lose my Medicare, as I am young and disabled and not a Senior citizen and I don't know how medicare's medical reviews work. I am a walking panic waiting to happen. So, I have to have everything planned out and like to have the broadest and most rounded information possible. You are all so helpful, and truly right now I would be a mess if it were not for finding this site. Enough of my blabbing. Have a great night.
Chelle

[Goofproof]

It doesn't seem silly to me. I too like to plan on controlling what happens to me. Life is tough, sometimes no matter how good we make decisions we get sideswiped, and pushed to the ditch.

No one has our best interest at heart like ourselves, many people have trouble in life because they make bad choices, but some make the right decisions and still fall down.

It is to these people I take off my hat. I wish you the best of luck, health and happiness.
Jim

[sapphireskye]

"It doesn't seem silly to me. I too like to plan on controlling what happens to me. Life is tough, sometimes no matter how good we make decisions we get sideswiped, and pushed to the ditch.

No one has our best interest at heart like ourselves, many people have trouble in life because they make bad choices, but some make the right decisions and still fall down.

It is to these people I take off my hat. I wish you the best of luck, health and happiness.
Jim"

Isn't that the truth. Thanks for the kind words Jim. Even when we plan, sometimes we just have to take the tumbles and go along with it.

I wish you well too
HAPPY 2006
Chelle