Grr. "Compliance" Does in Travel Plans

[Kiralynx]

So, my husband picked up his machine yesterday.

My plan (and my ratties earned me enough money with Barn Hunt practices to implement it -- good ratties!) had been to hit up our noble hosts for an identical machine so that he could do what I have done -- have a CPAP travel case with CPAP, power cords, extension cords, hanging hooks, a spare mask in case of cataclysm, etc. etc.

That way, when we travel, all he needs to do is grab the case, stick it in the car, and we DON'T get where we're going, and find we're missing something critical.

Well, it turns out that the insurance has stuck a new requirement in place: a modem to report to the doctor whether or not and how long he's using it. The usual compliance bit -- at least four hours a night, 90 nights.

We're going to be doing a bunch of travel in the next three months. VERY annoying.

[chunkyfrog]

Simple--put the travel machine away until the compliance period is over.
No travel machine can offer the exact same therapy as the regular machine;
and starting out is when we do not cut corners with therapy.
I took my first machine on a business trip inside of a week from starting.
Consistency really matters--especially at first.

[palerider]

Or, you could do what many truck drivers who have a machine in their truck, and one at home do..

take in both SD cards and say "figure it out".

[Pugsy]

Who told you 4 hours a night for 90 nights?
Your insurance company or the DME equipment supplier?

[D.H.]

Who told you 4 hours a night for 90 nights?
Your insurance company or the DME equipment supplier?

The DME wants you o be compliant; they want to be paid by the insurance.

The insurer has a different interest. They get away without paying if you're not compliant.

My suggestion is to the take the new machine with you. It's much simpler if you're traveling by car, as there is no bag limit.

BTW, you should have a dedicated packing list for your CPAP bag. You need this not only for vacation, but also in case you're hospitalized and somebody else needs to pack the bag.

[Pugsy]

Who told you 4 hours a night for 90 nights?
Your insurance company or the DME equipment supplier?

The DME wants you o be compliant; they want to be paid by the insurance.

The insurer has a different interest. They get away without paying if you're not compliant.

My suggestion is to the take the new machine with you. It's much simpler if you're traveling by car, as there is no bag limit.

BTW, you should have a dedicated packing list for your CPAP bag. You need this not only for vacation, but also in case you're hospitalized and somebody else needs to pack the bag.

My point with my questions was to verify if those stated compliance requirements were really from the insurance company or the DME simply making it up and telling another lie.
4 hours a night for 90 nights is really an unusual insurance requirement but I have seen DMEs lie about it to put the fear of god in people.

I don't like being lied to and for that reason I would verify with the insurance company directly.

The most common requirement mimics Medicare's compliance which is of course at least 4 hours a night for 70% of 30 consecutive nights and they have 90 nights to meet that requirement.

[D.H.]

As far as whether it's coming from the insurance company or the DME, I strongly suspect it's the insurance company. As I said before, the DME wants to be paid and the insurance company is looking for excuses not to pay!

[Pugsy]

As far as whether it's coming from the insurance company or the DME, I strongly suspect it's the insurance company. As I said before, the DME wants to be paid and the insurance company is looking for excuses not to pay!

And I am willing to be it isn't coming from the insurance company and instead coming from a DME who wants to put the fear of god in someone.

I don't like liars and I don't care what the reasoning is behind the lying. No excuse for it in my book.

I could be wrong....this insurance could be an outlier who doesn't find Medicare's requirements sufficient but the only way to know for sure is contact the insurance company and ask them directly.
We never, ever should take what a DME says at face value without verifying. Sure they want to get paid and are more than willing to lie about it to get it done.

[D.H.]

As far as whether it's coming from the insurance company or the DME, I strongly suspect it's the insurance company. As I said before, the DME wants to be paid and the insurance company is looking for excuses not to pay!

And I am willing to be it isn't coming from the insurance company and instead coming from a DME who wants to put the fear of god in someone.

I don't like liars and I don't care what the reasoning is behind the lying. No excuse for it in my book.

I could be wrong....this insurance could be an outlier who doesn't find Medicare's requirements sufficient but the only way to know for sure is contact the insurance company and ask them directly.
We never, ever should take what a DME says at face value without verifying. Sure they want to get paid and are more than willing to lie about it to get it done.

I guess I need to clarify. The need for compliance comes from the insurance company. However, it's entirely possible that the immediate push is coming from the DME. They want to be paid!

[Pugsy]

As far as whether it's coming from the insurance company or the DME, I strongly suspect it's the insurance company. As I said before, the DME wants to be paid and the insurance company is looking for excuses not to pay!

And I am willing to be it isn't coming from the insurance company and instead coming from a DME who wants to put the fear of god in someone.

I don't like liars and I don't care what the reasoning is behind the lying. No excuse for it in my book.

I could be wrong....this insurance could be an outlier who doesn't find Medicare's requirements sufficient but the only way to know for sure is contact the insurance company and ask them directly.
We never, ever should take what a DME says at face value without verifying. Sure they want to get paid and are more than willing to lie about it to get it done.

I guess I need to clarify. The need for compliance comes from the insurance company. However, it's entirely possible that the immediate push is coming from the DME. They want to be paid!

I get that insurance companies don't want to waste their dollars and thus have some minimum usage requirements.
I get that DMEs want to get paid and not take back machines.

What I don't get is the need to lie about requirements (which DMEs do quite often).
Tell me the truth and be done with it. What's so hard about that?

This isn't the first time I have heard of this 90 day every night 4 hour usage thing but every other time I have heard about it the poster comes back and says "guess what, I checked with my insurance company and it's not 90 days but instead it's 70% of 30 days" "When I ask the DME about it they admitted to stretching things just to put the fear of god in me"......

Duh....liars.

[rcobourn]

Just a note.. medical equipment is generally not counted against your bag limit, so don't worry about carrying on that CPAP travel bag. I've even carried distilled water in the CPAP bag without issue.

[Kiralynx]

Simple--put the travel machine away until the compliance period is over.
No travel machine can offer the exact same therapy as the regular machine;
and starting out is when we do not cut corners with therapy.
I took my first machine on a business trip inside of a week from starting.
Consistency really matters--especially at first.

I said I was buying the exact same machine as his regular one to use as a travel machine.

Absolutely no plans for "cutting corners."

[Kiralynx]

Who told you 4 hours a night for 90 nights?
Your insurance company or the DME equipment supplier?

DME equipment supplier. We have also been told that the information via the modem goes directly to the doctor, and that we must make an appointment to see him within 90 days.

[Pugsy]

The face to face within 90 days doctor visit is common.
Medicare requires that and a lot of insurance companies mimic Medicare.

You might want to call your insurance company and find out exactly what the compliance usage hours are.

You can't use a machine every night for 90 nights AND see the doctor before the end of 90 days at the same time.

Find out from the insurance company exactly what to expect.

[Kiralynx]

The DME wants you o be compliant; they want to be paid by the insurance.

The insurer has a different interest. They get away without paying if you're not compliant.

My suggestion is to the take the new machine with you. It's much simpler if you're traveling by car, as there is no bag limit.

BTW, you should have a dedicated packing list for your CPAP bag. You need this not only for vacation, but also in case you're hospitalized and somebody else needs to pack the bag.

Have you considered the merits of reading what I actually wrote instead of what you think I said?

If I have, and my husband has, a travel case with everything in it, identical to the set-up by our bedsides, there's no need for "a list." EVERYTHING is in the bag. You just grab the bag and go.

When we travel, we have my mobility scooter, two ARB car freezers, 3 suitcases, 2 CPAP cases, 2 kitchen boxes (which contain, among other things, 2 good sized extension cords), a bed step, 2 folding tables to set CPAPs on if the night stands are not suitable, 4 dog crates, bag of dog crate gear, and two dogs. Yes, there CAN be a bag limit, that being how much you can stuff into a Grand Caravan.