Anthem to Require Data Download

[The Latinist]

According to a letter I received from my DME, "Effective August 1st 2014, Anthem will require an actual CPAP data download before issuing authorization for CPAP supplies or on-going CPAP rental coverage." It seems Anthem wants to look at actual data and not just to rely upon the DME's word about patient compliance. The letter continued, "An authorization is required by Anthem regardless of whether or not supplies are a covered item." I assume that this is only because I am still in my 10-month rental period, but the letter is so poorly written that it's hard to say. It also both informed me that they could obtain the necessary data from the compliance modem attached to my unit and asked me to send them my SD card immediately. Has anyone else heard about this change of procedure?

I can't wait until this compliance period is over, and I intend to remove the modem from my device as soon as it is and have no more dealings with Anthem for any CPAP-related item in the future.

[JDS74]

For more information about this issue:

viewtopic.php?f=1&t=98418&p=913069#p913069

[The Latinist]

Yes, I read that thread. But this seems to be something else new, if I am understanding correctly. It sounds like Anthem wants to actually see the data.

[Bama Rambler]

I think the issue is what "they" consider data and what we consider data are two different things. They consider the compliance data al the "data" they need. Whereas, "we" don't consider that data much at all.

It sounds like what they (Anthem) wants is a printout of the compliance data instead of just taking the DME's word for it.