Sharing Resmed Airsense Data with new provider.

[jsmit86]

I have been using an Airsense 10 Autoset for about 4 years, and with the help of this board, I posted Oscar Charts and got my machine dialed in.
I typically have AHIs under 1.0 most nights, and I have been sleeping well.

I have pretty severe Asthma, and I have been seeing a respiratory Dr. who has done a great job treating that problem. During my last appointment, he inquired about my CPAP usage, and I was able to share my experience with the therapy. He mentioned that my insurance may be able to issue supplies, and that they would check into that. I have paid for my machine and supplies out of pocket due to not having great insurance coverage when I started CPAP.
My new insurance coverage is better, and may pay for supplies, and also for a new machine after 5 years, but they will need the compliance data.
I know that I can bring my SD card in, but when I started CPAP, there was an option for my Dr. to receive the data via the cellular data by Resmed.
If I want to do that, what is needed to provide the information to the doctor?

[ChicagoGranny]

I know that I can bring my SD card in, but when I started CPAP, there was an option for my Dr. to receive the data via the cellular data by Resmed.
If I want to do that, what is needed to provide the information to the doctor?

Will you buy your equipment and supplies from a local DME? If they have your machine's serial number, they can access the compliance information from the ResMed site.

Does your doctor want your compliance information? My local DME retrieves my data when they file a claim with my insurance company. My doctor doesn't look at my compliance information. At my annual visit, he asks me how I am doing. The DME's policy requires he send them a new prescription each year. My DME requests it once per year from the doctor.

The process is easy for me.

BTW, make sure the DME is in your insurance policy's network.

[jsmit86]

Thank you for the reply. I need to do a bit more research, but the medical practice is also the DME as far as I know.
So, if I share the serial # they can get the data. That answers the question.
All of this will depend on if it makes sense to go through insurance.

When I started therapy, my plan would not even count the purchase toward my deductible. The only option was to "rent" to purchase, and since that spanned 2 calendar years, the total cost was going to be almost double the outright purchase price. Due to that, I bought the machine and all of my supplies out of pocket.
I'm not sure how much my new plan will cover, but if I can get the masks, cushions and humidifier tubs cheaper, I may go that route.

I am also wondering if I will need another sleep study when it's time to replace the machine. I wonder if the data from the machine may possibly suffice.
I can always bring in the SD card, but if it's easier for them to pull the data, I may go that route.

[SleepGeek]

the medical practice is also the DME as far as I know.

IF it were me I would not do business with a doc the sells the same equipment he will suggest I use - the reason is simple - he will be more interested in selling for his profit than treating for my health.

I'm not sure how much my new plan will cover

Call your insurance to ask this and any other questions.
Again the reason is I don't see how you will get an unbiased answer from this doc.
In fact, I would be looking for another doc for any future needs.
Write all your questions down before you call your insurance leave room under the question to write their answer.

I am also wondering if I will need another sleep study when it's time to replace the machine

While on the phone with insurance I would also ask this question. Everyone should have a copy of their sleep study and the equipment order. I'm willing to bet that your insurance will accept that study but it will likely have to be confirmed by the doc (hopefully a new or diff doc).

In fact, with a copy of this sleep study you may not have to wait for the 5 yr mark. Which would be great.

[dataq1]

I am also wondering if I will need another sleep study when it's time to replace the machine.

I can tell you that Medicare will accept your old sleep study. I've replaced two machines (>5000 hours) on the same sleep study from 18 years ago. Your medical carrier may have different guidelines.

I wonder if the data from the machine may possibly suffice.

If you mean AHI data from your current machine to act as a sleep study, the answer is likely NO. The data from your current machine is considered treated results, in a sleep study the insurer wants untreated results. (and again I only refer to Medicare as basis for my experience).

[jsmit86]

the medical practice is also the DME as far as I know.

IF it were me I would not do business with a doc the sells the same equipment he will suggest I use - the reason is simple - he will be more interested in selling for his profit than treating for my health.

I'm not sure how much my new plan will cover

Call your insurance to ask this and any other questions.
Again the reason is I don't see how you will get an unbiased answer from this doc.
In fact, I would be looking for another doc for any future needs.
Write all your questions down before you call your insurance leave room under the question to write their answer.

I am also wondering if I will need another sleep study when it's time to replace the machine

While on the phone with insurance I would also ask this question. Everyone should have a copy of their sleep study and the equipment order. I'm willing to bet that your insurance will accept that study but it will likely have to be confirmed by the doc (hopefully a new or diff doc).

In fact, with a copy of this sleep study you may not have to wait for the 5 yr mark. Which would be great.

Thank you for the reply.

I have a copy of the sleep study, and CPAP Rx. I am not on Medicare, and Insurance companies requirements can vary.

I know the Practice provides Resmed products based on the displays in the office where the sleep practice is located. Based on my experience I will likely insist on Resmed again at replacement time, so I am not concerned about some DME pushing some inferior product.

The Doctor I am referring to is my Respiratory MD, and has done better than any other doctor in treating Asthma that has been a major problem for me for over 40 years, so while your opinion is duly noted, I will continue to see him. I am not certain that there is not a separate DME from the practice, but I know that they coordinate with one if they don't actually own it. I am also aware that I can spend my own time on the phone with the insurance company, but if I can get the supplies for little or no out of pocket without me spending my time on the phone, I am OK with that. Again, I don't need replacement yet, but I might be eligible in 2023, so I'm just getting prepared. (Basing that on the typical 5 years, knowing that could vary with the insurance company.)

[Janknitz]

You should know that state laws in many states prohibit doctors from dispensing DME or having a financial interest in a DME company because of the conflict of interest. But evidently not in your state. Since you know what you need, you can be an aware consumer and know when something is being pushed on you for profit rather than need.

When you contact your insurance company, ask for a copy of the "Evidence of Coverage" (EOC). That is the actual contract with your insurer that you've never seen unless you knew to ask for it. This will tell you exactly what DME is covered, how it is covered, and what documentation you need. It will tell you if it will cover an outright purchase or a capped or forever rental, and the supply replacement schedule.

Sounds like this doctor is familiar with your insurer and knows how to document to get coverage. But especially since this doctor is trying to be a one stop shop, you want to make sure YOU understand what your out of pocket costs will be.

[Pugsy]

It's against a FEDERAL law for a doctor to sell stuff to Medicare patients....big potential conflict of interest and Medicare laws are real specific about it. Can't even be a family member of the doctor that is dispensing the equipment.

Now other insurance companies might look at it differently and state laws do vary so best if someone has something other than Medicare to check with their individual insurance.

Now don't assume that just because a doctor has a supplier within his office that the doctor has a finger in that pie.
It could just be that the provider of cpap equipment is an independent provider and has nothing to do with the doctor or the doctor's financial interest.....but let's face it...it does sort of smell a bit of potential improprieties.

My hand surgeon doctor had a place in his office that did PT and made splints....but they weren't part of the doctor's practice and the doctor didn't have anything to do with them other than the convenience of having them handy. It was made very plain to me that the PT part and the splint making part was totally independent of the doctor's part. That's the way it should be.

[ChicagoGranny]

Now don't assume that just because a doctor has a supplier within his office that the doctor has a finger in that pie.
It could just be that the provider of cpap equipment is an independent provider and has nothing to do with the doctor or the doctor's financial interest.....but let's face it...it does sort of smell a bit of potential improprieties.

The sleep doctor I saw for a number of years provided a small office in their facility two days a week to a local DME. This was very convenient; some patients told me they liked it. The DME did machine delivery and setup, mask fittings, and delivered supplies. They billed the patients' insurance companies.

I used a different DME that was in the next town. The doctor's staff told me they were good to work with. I took this as an indication the doctor was not biased toward the onsite DME.