CPAP Compliance

So I was curious if I am meeting the requirements for compliance. According to my healthcare provider compliance is defined as:

"Adherence to therapy is defined as use of PAP four hours or more per night on 70 percent of nights during a consecutive thirty-day period anytime during the first three months of initial usage."

According to OSCAR, for the last 30 days I am at 88% for using the machine 4 hours or more. I missed two days of therapy by a matter of minutes. Do I really need to be at 100% for my insurance to sign off on the machine and let me keep it?

100%--what? Of 4 hours?
70% of 30 days is more like 21 days.
If your machine reports exactly 4 hours on too many nights,
it could be rounding up, meaning those nights were incomplete as well.
You can let your machine run while you are awake to push hours ABOVE 4 hours.
It cannot tell if you are asleep or not.
Then, and only then, can you be sure you filled the requirement for that night.
As you get used to therapy, using cpap will get easier.

All I know is what I quoted. I only have one day at exactly 4 hours, two days I was below that mark, the rest are 5 hours or more with the average of 6. What I am guessing is that I failed the compliance test so in a few days I am going to pack it up and take it back to my DME.

kona0197 wrote: ↑

Wed Jul 27, 2022 11:39 pm

All I know is what I quoted. I only have one day at exactly 4 hours, two days I was below that mark, the rest are 5 hours or more with the average of 6. What I am guessing is that I failed the compliance test so in a few days I am going to pack it up and take it back to my DME.

From 30 days, if you delete the two that were below 4.0 and the one that was exactly 4.0, you still have 27 days left. 27 out of 30 is 90% so you passed. As ChunkyFrog said anything above 21 days exceeds 70% and is a pass.

You just quoted it yourself...You only need compliance 70% of the time during a 30 day period.......70% of 30 days is 21 days out of 30. YOu can miss 9 days and still be compliant.

Thanks everyone. Guess the math wasn't adding up in head due to the way the rules were written.

You asked the same question a year ago. Did you lose that machine?

Every year you seem to come around having gotten a new machine and then have problems using it.

Instead of asking about compliance, you should probably be asking for advice on what you can do to be successful.

No, it's the same machine from last year. My healthcare provider wanted another compliance report done. I don't know why. Last year I passed with flying colors.

And I don't think I get a new machine every year. I've only owned 3 in the last ten years.

It's normal to require an annual compliance report.

My provider said that I have to use the machine 21 days out of 30 for a minimum of 4 hours per night. I pay a rental fee for 12 months of $9.63 and the insurance company pays a monthly fee which with my copay pays for the machine in 12 months. After that the machine is mine.

ChicagoGranny wrote: ↑

Fri Jul 29, 2022 10:54 am

It's normal to require an annual compliance report.

My state healthcare has different requirements. The machine is rented to you for three months. During that 3 months you must have 70% usage of 4 hours or more per night. So yes, you can miss a few nights and still be covered. After that, the state pays for the machine and it's yours.

I did all that last year, so I'm confused why they need another compliance report. As far as I know the machine was paid off.

Your state may require another compliance check for you to continue to get masks, etc.

Or the supplier itself (the DME) might have some sort of in house rule that has nothing to do with your insurance and they blame your insurance.

It's always best to ask questions directly to the insurance itself though. DMEs don't always know the ins and outs of every single insurance out there and they don't always tell the truth either.

It isn't uncommon for insurance companies to want to make sure you are still using the machine before they go paying for masks, etc. All depends on the insurance company.
Or some insurance companies are good with your doctor just saying that you are using it and doing well.

My DME says 3B medical gets a report from my machine, which has a cell connection and they send the report to my pulmonary doctor and UHC insurance every three months.

My Doctor said I had six months to get up to complIance (I am brand new to this). My DME had told me 3 months. After 6 or 7 weeks I have managed to get 4 hours once. Normally I do a half hour before bed, then take it off so I can actually fall asleep. I am seeing my Doctor on 8/11 to hopefully get sleeping pills or something to see if I can actually sleep with a mask and hose on and air being rammed down my throat. Hopefully I get 6 months.