Compliance

[babydinosnoreless]

How long do Insurance companies track our data ? Is it the for the first 90 days only or do they track us foe the full 14 months until the machine is paid for. I have bc/bs.

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[prodigyplace]

I suspect is is at least until your machine is paid for. If you use them for supplies, they will likely track after that
My BC/BS insurance (KeyCare 300) rent to own was only 10 months almost 2 years ago.

[LSAT]

The treating physician must perform a clinical
reevaluation no sooner than the 31st day, but
no later than the 91st day after initiating therapy,
which documents the following:
• A face-to-face clinical reevaluation by the
treating physician with documentation that
symptoms of OSA are improved; and
• Objective evidence of adherence to use
(defined as use of PAP devices for 4 or more
hours per night on 70% of nights during a
consecutive 30-day period anytime during
the first 3 months of initial use) of the PAP
device, reviewed by the treating physician.

[babydinosnoreless]

Thanks. I've had that follow up appointment so hopefully I am good.

[mbushroe]

Strange. In my case the only time insurance leaned on me to make sure the expense was justified and that I would use it was for only one month. They required at least 21 days of four hours or more of use in the first month and that was it. I actually came close but failed my first month and let me try a second month. I worked very hard on meeting the requirement so that I could the machine, and then after the insurance test cycle, I hardly ever used it. Probably because whether I used it or not I still woke up each morning feeling tired and without energy. But it would probably have stopped me from getting more machines until now when I am using it most nights.

I am glad I didn't have to prove the entire time to pay off the machine, what ever that meas. If the "money" to pay for it comes from the insurance company's account the everyone pay into then they have orders of magnitude over the cost of one machine. If they are saying how long your personal premiums pay for it, that is not the business model they work from. On the other hand, they seem to be able to make and enforce just about any rule they want.

[D.H.]

I've been using CPAP since 1999, but still needed to show compliance on machine #4 (not on the first three). Of course, I passed easily as all my compliance issues are ancient history.

[Pugsy]

The best and most accurate answer would need to come from your insurance company directly.
Not all BC/BS plans are equal and not all coverages are the same.
Call them up and ask them.
Don't rely on what the DME might say....get the answer directly from your insurance company.
Most insurance will mimic Medicare's compliance requirements but not all will....so you need to ask the insurance company to know for sure.

[zoocrewphoto]

Best to ask your insurance company.

mine required me to meet one one month of compliance during the first 3 months. They start off as a rental, and convert it to full purchase if the person meets compliance. So, mine paid one monthe rental, then paid off the machine. Then, I was billed for my copay. I got supplies here and there for the first couple years with insurance. Then stopped making the deductible, so I just buy what I need via craigslist or ebay. I have a second machine that I bought used, so I have not gotten to a point of using insurance again.

I don't consider it a big deal though. It is only hard when you first start out. getting used to the machine. finding the right mask, etc.

[prodigyplace]

As a comparison, ny BS/BS KeyCare 300 plan was a 10 month rent to own, with insurance paying 80%.

I needed to be careful though, because Lin(don't)Care tried charging an extra month.

[edatlanta]

My DME has billed medicare for 10 months so far with number 11 due today. As far as I remember it was a 12 month rental (maybe 13 months was mentioned, but I don't recall).

Compliance I was told was only monitored for the first 3 months and nothing after that. I really don't care since I'm at 99.999% usage. I think I had one night with just under 4 hours and haven't missed a single night since day one.

I sleep easy knowing that I don't care about compliance.

[babydinosnoreless]

I called the insurance company yesterday and got so mad with the dme I forgot to ask the compliance question. Well apparently since I have started my insurance has paid everything but $95 dollars. Because they are in my plan they are NOT allowed to charge me more. But they have charged me so much more ....

They have no limit on the supplies I can get. Just what I need. Don't be excessive. So the hose my dog chewed up, a new mask because I am having issues would all have been covered. My dme made me pay for a new hose and said I couldn't have a new mask till next year.

I called to ask them about it but of course they haven't called me back. *sigh*

Anyway insurance told me I can get my supplies from any supplier on my list. Apria is on there as well as several I've not heard of. Will call around and see who actually calls me back.

[prodigyplace]

I called the insurance company yesterday and got so mad with the dme I forgot to ask the compliance question. Well apparently since I have started my insurance has paid everything but $95 dollars. Because they are in my plan they are NOT allowed to charge me more. But they have charged me so much more ....

They have no limit on the supplies I can get. Just what I need. Don't be excessive. So the hose my dog chewed up, a new mask because I am having issues would all have been covered. My dme made me pay for a new hose and said I couldn't have a new mask till next year.

I called to ask them about it but of course they haven't called me back. *sigh*

Anyway insurance told me I can get my supplies from any supplier on my list. Apria is on there as well as several I've not heard of. Will call around and see who actually calls me back.

That is good news.

If your DME is "in network" with your insurance company, the DME agrees to not charge more than the insurance allowable amount. You may be due a refund if you complain to your insurance company.

My DME insisted I could not get a heated hose because insurance never covers it. I produced my copy of the preauthorization letter they received and they still insisted. I said sell me the hose anyway and submit to insurance. Insurance covered it as expected.

[Okie bipap]

Some people have had good results working with Apria. Results vary from location to location. Personally, I have never used them. I really liked my first DME, but they lost their Medicare contract so I changed companies. I currently use an on line company that specializes in military and retired military. I am thinking about dropping them and going to a local company. There is a new Medicare approved supplier located less than ten miles from my home.

If you do start using Apria, get a prepaid Visa or Mastercard and use that for your purchases. Only keep enough money on the card to cover your supplies.