What will insurance companies really accept as compliane?

[archangle]

It's usually for a 30 day period. Maybe the last 30 days, maybe for any chosen 30 day period.

If you get the next 11 days, will you have 21 total in the last 30 days before you turn in the card?

[rested gal]

I did a lot of searching, and everything I could find indicated that insurance compliance was based on "number of nights with greater than 4 hours."

You're right, archangle. I was repeatedly using the word "usage" in my post when I should have been using the word "compliance." Minimum compliance is generally considered to be at least 4 hours a night for 70% of the nights within a 30 day period. As you explained. Thanks! (I don't think it has to be "greater than" four hours...it can be "greater than or equal to" four hours, I believe.)

[ameriken]

Cherylann, I know you've had some problems and issues with CPAP and sleeping and such, however I do hope and pray you are somehow able to find a way to sleep with it for 6 to 8 hours a night, so that compliance is a non-issue and your health is positively impacted.

[cherylann]

i just spoke to BCBS about my plan. They told me that it is up to the patient whether to rent or buy (assuming there is a prescription or statement from a doctor as to medical necessity). In my case, since I had already met my deductible and out of pocket for the year then the nearly $200 I paid the DME was not necessary. So I have called the DME and told them to switch it from a rental to outright purchase and refund me my money.

Also they told me that BCBS does not require downloads, reports or anything else documenting compliance.

[Roger2]

Also they told me that BCBS does not require downloads, reports or anything else documenting compliance.

I think that is probably correct as I have been on my cpap since mid June (about 3 months now) and no one has asked me for anything including Anthem Blue Cross/Blue Shield. Seems like if they were going to ask they would have done it by now. I asked both my lung doctor and my primary care doctor and neither have been asked for anything.

Roger

[Perrybucsdad]

Do the insurance companies only look at the first 30 days? I mean, if a year goes by and I need to buy some new stuff (hose, mask, whatever) will they want to see compliance data all over again? I'm not on Medicare or Medicaid, so I don't know if that has any impact.

[JohnBFisher]

Do the insurance companies only look at the first 30 days? I mean, if a year goes by and I need to buy some new stuff (hose, mask, whatever) will they want to see compliance data all over again? I'm not on Medicare or Medicaid, so I don't know if that has any impact.

Normally, once you are on the unit and they've paid for it, most insurance companies no longer care about the compliance data.

[msradar65]

i just spoke to BCBS about my plan. They told me that it is up to the patient whether to rent or buy (assuming there is a prescription or statement from a doctor as to medical necessity). In my case, since I had already met my deductible and out of pocket for the year then the nearly $200 I paid the DME was not necessary. So I have called the DME and told them to switch it from a rental to outright purchase and refund me my money.

Also they told me that BCBS does not require downloads, reports or anything else documenting compliance.

That sounds about right. I had BCBS and they did check compliance the first 30days. I did an outright purchase as I had met my deductible. So you really only have to worry about the first 30 days. I know they checked my card twice in the first 30-45 days or so.

I would definitely speak with the DME....sounds like they are trying to take advantage of your.

[archangle]

i just spoke to BCBS about my plan. They told me that it is up to the patient whether to rent or buy (assuming there is a prescription or statement from a doctor as to medical necessity). In my case, since I had already met my deductible and out of pocket for the year then the nearly $200 I paid the DME was not necessary. So I have called the DME and told them to switch it from a rental to outright purchase and refund me my money.

Also they told me that BCBS does not require downloads, reports or anything else documenting compliance.

Wow that's great!!!

Now you're going to wake up and realize that phone call was just a dream.

Be prepared for the possibility that the insurance may change their tune before all the bills get paid.

Now, that all that anxiety is gone, let's get you using the mask all night long.

By the way, don't be TOO hard on the DME. Even the people who work for the insurance companies often can't give you the same answer two times in a row. And DMEs have to work with multiple companies, and multiple policies from the same companies, and cases where one company issue the insurance and another company administers payments based on the first company's policies.

[chunkyfrog]

In cases where insurance REQUIRES documentation of compliance for continued coverage,
some have worn the unit while awake to round up the time.
I know of no patient-owned machine that can tell whether or not you are sleeping.

[physicsbob]

BCBS Called me twice on the phone to verify compliance, once at 1 month and another about 6 months. They just asked if I was using it and how much. However the thing that I don't like about my BCBS plan is that they won't buy a replacement after 5 years. If your unit breaks they will try and get it repaired, if they can't they will send you a refurbished one. I went ahead and bought what I wanted outright form cpap.com because it was cheaper than my deductable and a lot less hassle with my DME. I will say that since I complained to BCBS about my DME my DME has been a lot more pleasant and helpful to me.

[cherylann]

.[/quote]

Wow that's great!!!

Now you're going to wake up and realize that phone call was just a dream.

Be prepared for the possibility that the insurance may change their tune before all the bills get paid.

Now, that all that anxiety is gone, let's get you using the mask all night long.

By the way, don't be TOO hard on the DME. Even the people who work for the insurance companies often can't give you the same answer two times in a row. And DMEs have to work with multiple companies, and multiple policies from the same companies, and cases where one company issue the insurance and another company administers payments based on the first company's policies.[/quote]

I'm really working hard at it. Sunday and Monday nights I did pretty good - around 4 hours and last night too. Except that I woke up about 3:00 suffocating and breathing really hard. I checked my heart rate and it was 118.

[archangle]

Except that I woke up about 3:00 suffocating and breathing really hard. I checked my heart rate and it was 118.

Does your data show anything interesting at that time? Maybe we should start another thread.

[cherylann]

Except that I woke up about 3:00 suffocating and breathing really hard. I checked my heart rate and it was 118.

Does your data show anything interesting at that time? Maybe we should start another thread.

I haven't looked at it. I left the next morning for a business trip to Dallas. But, that's a good idea. I'll check it when I get home tonight and start a new thread. I'm really getting worried about this - my heart rate flucuates wildly.

[Roger2]

. . . my BCBS plan is that they won't buy a replacement after 5 years.

That depends; if you have a conventional policy such as one through your employer, that is probably correct but if and when your company changes carriers, you can then change it. If however you are on medicare and have a supplement or a medicare advantage plan the insurance company does not have a choice. They now only charge rent for 3 years and you keep the unit another 2 years, for a total of 5 years. The last 2 years the provider is not allowed to charge additional rent but they must keep servicing it. CMS ( who set the rules for medicare) allows for a life of the unit to be 5 years after which the provider has to replace it and the new rental period must provide a new one. The provider keeps ownership (under medicare rules) of the old unit and can if they choose take it back. Apria here in Colorado says they don't want the unit back as they are not interested in becoming embroiled in a products liability suite for a reconditioned unit.

Hope that helps.

Roger