Dr.'s office called, wants follow-up, might not go

[Popi]

See, I have TriCare, and as I understand it, the patient is supposed to go back after 90 days to confirm compliance. Well, to be honest, it took me about six months of VERY sporadic attempts to finally become compliant (that, and finally finding this site and information about other masks). Now, after almost a year, I get a voicemail informing me that I NEED (verbal emphasis on the message) to make an appointment for a follow-up. There was an initial follow-up appointment set, but because of crazy weather, the doc's neighborhood was flooded and he had to cancel, and at the time, I didn't know about the 90-day compliance check.

So, should I go back? My numbers are awesome, I'm feeling much better...and I don't want to loose my machine due to a slow start on my part.

[roster]

I can't judge what you should do, but I rarely ever visit the sleep doc. I have the software to check my AHI and a pulse-oximeter for occasional overnight studies and I know how I feel.

For what reason would you want to see the doc?

Is your machine paid for? If it is on rental the insurance company may require a compliance check to keep paying. Or they may require a compliance check to pay for new masks and supplies.

[Popi]

The machine will be paid for next month (13 month rental).

I have no reason to see the doc, but you might be correct, there might be a complience requirement for continued coverage of masks/tubes..etc.

I call the office and see what they have to say. My guess, the doc has a kid in college and needs the money.

[KatieW]

I've never gone for a follow-up, because I'm doing well, and I purchased my cpap and supplies out-of pocket. But if it's a insurance requirement, like you need a new RX, I would. Go with a list of questions about sleep apnea, ask to go over your sleep study, or any other health concerns. Might as well get some information at that appointment, and not just the usual "you're doing great, see you in a year".

[sleepnationtv]

All the doctor needs for the compliance check is a download of the machine. Technically trickle with Medicare will not pay for your machine if they did not show you being compliant within 90 days but it sounds like they paid. Just tell the doc you will send in a download card but you don't want an appointment.

[Janknitz]

Here's my advice: Print out your data for the past 3 months or so of good compliance and take that with you to the doctor's office, not the machine or the card. The doctor has to verify that you are being compliant and that the treatment is effective for you. Your print outs will provide the necessary evidence--you can give them to your doctor to put in your file.

The doctor may want to see the machine or card, but that's the doctor's problem. He will have enough information to document your compliance and efficacy. If he wants to make any changes to your therapy, smile sweetly and ask him what new settings he wants, then go home and change it to those settings yourself.

The doctor may not like it. Too bad.

[WearyOne]

For what it's worth, my machine was on a 13-month rental, after which it was considered mine and paid for. I never took my machine in, never took my card in, and no one anywhere ever asked for it. I went back once to the sleep doc and took some printouts from the software, which he was very interested in, but I can't even remember if he kept them or not. He may have, but it sure wasn't three months' worth. Never had a problem with the insurance company saying they needed it either. (It was either Anthem or Cigna; can't remember which right offhand.)

Pam

[kempo]

As for as insurance paying for the machine I would think that data should be sent in by your DME. That's who the insurance company will be paying for the rental.

My insurance company required me to attend one follow up to the sleep clinic to see the doctor. Compliance data for the rent to own will be sent in by my DME.

[Mary Z]

Popi, I don't think you would lose your machine due to slow compliance on your part. The doc's office does not know you're doing fine with good numbers. Once they see you're using the machine and understand how to interpret your daily data maybe they will only need to see you on an as needed basis. I personally appreciate a physician who will follow up with me to make sure all is ok. Many folks need help.
Glad you're not one of them.

[KC5cychris]

Popi

I too use tricare. They follow the same lines as medicare they only care about compliance 90days data will probaply all that matters, 4hrs per day is compliant. you will be ok

[bjdare]

You might consider calling Tricare and asking about their requirements for cpap compliance and continued coverage for masks, supplies, etc. I have Aetna and also "purchased" my machine at 13 months. During that time, neither Aetna or the DME ever inquired about my compliance. I did follow up with the idiot Doctor (who was also associated with the sleep lab) after 30 days, only because I was naive and had not found cpaptalk.com. It seems to me that if neither Tricare or the DME have contacted you within the last 12 months regarding compliance, it would be a moot issue at this point. Supplies could be an issue with the DME - mine (god help me, Apria) wants a new prescription EVERY year. I just purchase everything out of pocket at this point, it's really cheaper! I tend to agree with you regarding the Doctor's motive - time to pick your wallet...or perhaps his butt in in a sling for not reporting your compliance 9 months ago.

[jweeks]

So, should I go back? My numbers are awesome, I'm feeling much better...and I don't want to loose my machine due to a slow start on my part.

Hi,

Another question to consider is if your prescription is still current. Since you need a prescription to buy a new machine and even to buy some supplies, you want to keep it current. The clinic that I go to puts an expiration date of one year on the prescription. I don't know if that is a legal thing, a CYA thing, or a marketing trick. I also don't know if any vendors actually pay attention to the expiration date on the prescription.

-john-

[lovecpap]

Tricare requires an annual cmn renewal. If you want to receive supplies or have that 13th month of rent paid you need a new cmn signed by the physician. Most physicians require you to come in before they sign the cmn. No complance requirements.

[jaydub]

This is no longer true. Tricare now considers CPAP machines exempt from the continual medical necessity requirement. Once you have a machine, your set for life unless you initiate something. This includes replacement supplies.

[SewTired]

This is no longer true. Tricare now considers CPAP machines exempt from the continual medical necessity requirement. Once you have a machine, your set for life unless you initiate something. This includes replacement supplies.

I agree that Tricare no longer requires you to keep providing medical necessity. Many states still require that you get a new prescription annually for supplies sold by local DME. This is separate from insurance coverage. It's easy enough to check on.