Worried I won't be able to meet the compliance requirements

[DougVK]

My insurance requires 30 day compliance, there is no 60 or 90 days, just 30 days. You must use the machine atleast 4 hours for atleast 70% of the days in the first 30 day period, if not they won't pay for it. I don't think I met this requirement due to vacation and such. worried now they won't pay for the machine or any supplies. It is rent for 2 months only, and own after that. They only look at the first month for compliance though.
Anyone ever had to deal with not meeting compliance?

[LSAT]

My insurance requires 30 day compliance, there is no 60 or 90 days, just 30 days. You must use the machine atleast 4 hours for atleast 70% of the days in the first 30 day period, if not they won't pay for it. I don't think I met this requirement due to vacation and such. worried now they won't pay for the machine or any supplies. It is rent for 2 months only, and own after that. They only look at the first month for compliance though.
Anyone ever had to deal with not meeting compliance?

You should have used it while on vacation...wherever you go, the CPAP goes along. Call your insurance company and discuss it with them.

[bdp522]

Pretty much anyone with insurance needs to show compliance. You say vacation got in the way...why didn't you take the machine with you? You can try calling the insurance and asking for another 30 days. The insurance requirements for compliance are just for insurance, you need to use the machine everytime you sleep for as long as you sleep. It is hard in the beginning but gets easier as you go. You might possibly try telling them you had mask issues(sore spot that needed to heal)and that was why you missed some nights. They might just let you have another 30 days.

Brenda

[robysue]

My insurance requires 30 day compliance, there is no 60 or 90 days, just 30 days. You must use the machine atleast 4 hours for atleast 70% of the days in the first 30 day period, if not they won't pay for it. I don't think I met this requirement due to vacation and such. worried now they won't pay for the machine or any supplies. It is rent for 2 months only, and own after that. They only look at the first month for compliance though.
Anyone ever had to deal with not meeting compliance?

70% of 30 days is 21 days. So you insurance company wants you to have used the CPAP for at least 4 hours on 21 days out of the first month.

And as LSAT points out, CPAP is not a "part-time" therapy: The CPAP machine goes with you when you travel. And ideally you use it EVERY NIGHT, ALL NIGHT LONG when you are sleeping. And for naps.

Inconvenient? Yes. Bothersome? Yes. Critically important to your health? Yes.

Because the dirty little not-so-secret fact is that the CPAP can't do its job in managing the apnea and its nocturnal O2 desats and arousals until you are sleeping with the machine ALL NIGHT, EVERY NIGHT. And you likely won't feel much better until you are sleeping with the machine ALL NIGHT, EVERY NIGHT.

Think of it this way: If you were a type II diabetic, do you think you could take your meds part time? Do you think you could simply not take the meds because you went on vacation or because they weren't convenient?

Now of course, the difference is that your insurance company probably would continue to pay for the diabetes medicines regardless of whether you took them or not, but it won't pay for the CPAP machine if you aren't using it. Probably a penny-wise, pound-foolish type of decision by the bean counting bureaucrats since some folks need more than 30 days to really adjust to sleeping with the machine and become compliant. But the rules are what they are and you have to figure out how to live with them if possible.

You may need to file a formal, written appeal if the insurance company denies coverage because of lack of compliance. So you want to start looking into exactly how to do that according to your insurance company's rules. You may need to have your sleep doctor or PCP back you up on the appeal. They may need to explain why they believe that you will become compliant, say in the next thirty days. And if you and your doctors have to make such a promise, then you need to be committed to making sure that you satisfy the conditions of the promise---and ideally not just barely satisfying them.

Best of luck

[DougVK]

I left the power supply at home by accident on the vacation. I posted in another thread that I also have a circadian rhythm disorder. This prevents me from sleeping a full 4 hours some nights. I lost 5 days from vacation and 7 days due to my CRD.

[robysue]

I left the power supply at home by accident on the vacation. I posted in another thread that I also have a circadian rhythm disorder. This prevents me from sleeping a full 4 hours some nights. I lost 5 days from vacation and 7 days due to my CRD.

Has the circadian rhythm disorder been officially diagnosed? If so, a note from the diagnosing doc about how it can prevent you from sleeping four hours on some nights is in order. If you can establish that you used the mask ALL NIGHT (as in the whole time you slept) for the days that you weren't on vacation with the missing power supply that should help your case.

[CBB]

My insurance requires 30 day compliance, there is no 60 or 90 days, just 30 days. You must use the machine atleast 4 hours for atleast 70% of the days in the first 30 day period, if not they won't pay for it. I don't think I met this requirement due to vacation and such. worried now they won't pay for the machine or any supplies. It is rent for 2 months only, and own after that. They only look at the first month for compliance though.
Anyone ever had to deal with not meeting compliance?

You may find compliance not to be a problem once you get started on it. After my first night, despite having to get used to it and swallowing a bunch of air and working with the fit and all of that.. even losing probably two hours sleep to all of that.. I was SO much more rested the next morning. CPAP totally changed my life for the better. Anger management problems gone, depression gone. I've been on 13 yrs and the few times I've been without my machine, I simply chose to stay up or prop myself upright in a chair rather than go through choking for my life. I think it is the IDEA of it more than the reality of it that keeps people from being compliant. Don't psych yourself out.. you may find your CPAP turns out to be a 'trusted friend'. My wife of 22 yrs says that CPAP saved our marriage, and there is no doubt in my mind, it saved my life. For that alone, well worth the occasional sore spot on my nose or wake up crash when the hose catches something on my nightstand. Rather than work yourself up to a non-compliant situation, try to think that you will be positive about it and be calm and patient with yourself and the machine.

[Alshain]

I travel on business a lot and there are things to note about traveling. Yes, you should take your CPAP always however you don't HAVE to take the humidifier if you think you can tolerate using the CPAP alone. This will cut back on the weight because you DO NOT want to check your CPAP. Some will say they can't live without the humidifier but that is really up to you to decide. Just make sure you take the right equipment, some of the CPAP's use different hoses in different circumstances (S9 heated hose for example).

Regarding gate checking your CPAP, it is medically exempt from the "1 carry on, 1 personal item" rule (at least in the US) and can not be taken from you, even at the gate, even if you have a laptop and a roller bag, even if it is a small plane where they don't allow more than 1 personal item and you have a laptop. It simply does not count as a carry on, it counts as nothing.

EDIT: Also when going through security, treat the CPAP like a laptop. (Take it out of the bag, etc)

[Roger2]

Has anyone told you how the insurance company would go about certifying compliance? I think that the built in reporter at least on mine only holds the data for a 24 hour period. It does have an SD card but after downloading the information the last time I reformatted the card. No one has advised me anything about preservation of the data stored in it nor has there been any warning about using the SD card.

The insurance company cannot dream this up after the fact and in the absence of any hard data, would not be able to sustain a denial of coverage based upon their speculation of how much they believe you might have used it. This would seem like a good time to assert your Fifth Amendment rights (only jesting of course, this is not a viable defense for civil matters).

You might want to check with your State’s insurance department as the numerous unfair claims practices acts are usually somewhat complex, let them sort it out for you.

[Alshain]

Has anyone told you how the insurance company would go about certifying compliance? I think that the built in reporter at least on mine only holds the data for a 24 hour period. It does have an SD card but after downloading the information the last time I reformatted the card. No one has advised me anything about preservation of the data stored in it nor has there been any warning about using the SD card.

The insurance company cannot dream this up after the fact and in the absence of any hard data, would not be able to sustain a denial of coverage based upon their speculation of how much they believe you might have used it. This would seem like a good time to assert your Fifth Amendment rights (only jesting of course, this is not a viable defense for civil matters).

You might want to check with your State’s insurance department as the numerous unfair claims practices acts are usually somewhat complex, let them sort it out for you.

Most machines hold number of days used > 4 hours. The machines also usually store the data both internally and on the SD card from what I have been reading. I know this for at least the S9 and PRS1 cause I've been researching them in the hopes I can scrounge up enough to afford one.

[archangle]

The SD card in most Philips Respironics or ResMed machines will hold several months worth of records telling when you turned the machine on, when you turned it off, whether you actually had the mask on and were breathing, etc.

I think some of the machines remember some of this info, even if you erase the card.

If you erase the data card, I wouldn't be a bit surprised if insurance denies your claim.

If you manage to not get booted out entirely, wear the CPAP while watching TV, reading, etc., if you can't get to sleep. These hours usually "count" to the machine.

It's usually 4 hours total usage per day, not 4 hours in one chunk. You probably can't fool the machine by simply turning it on and letting the air flow, plugging the hose, etc. A "day" is usually noon to noon.

Your machine will show you how many days of compliance it thinks you have over the past 7 or 30 days.

Have they asked you for the data card? Sometimes they don't even ask. When is your 30 days up? Get 4 hours every night by hook or by crook until your compliance is checked. Maybe they'll be a little slow and you can get a "good" 30 day period before they check. Maybe you can be a little slow turning in the card and get your good 30 day period.

[DougVK]

Good News people, I was compliant. The card actually had 55 days of data on it, and I assume they were actually allowed to use any 30 days in the 55 day period not just the first 30 days.

[robysue]

That is good news.

Now you need to work hard on getting genuinely compliant not for the insurance company, but for your own health needs: Work hard on making sure you sleep with the mask EVERY NIGHT, ALL NIGHT. And if it's a night where you don't sleep for four hours, but you do have the mask on the full time you sleep, count that as "compliant" for your own health needs.

But to start feeling the benefit of the CPAP you will most likely need to start working on that sleep problem that keeps you from sleeping even four hours on some nights.

Best of luck

[ozze_dollar]

Oh well i dont need to worry about compliance. I have to pay for my stuff anyway but hey...I am a free man. the same with my pension. I dont qualify for a pension but thats ok they have no hold on me.

BTW my compliance would be100%.