Letter from Lincare Regarding Compliance

Attached is a letter from Lincare stating that I’m not in compliance with CPAP therapy.
Little do they know that I have other health issues that make it very difficult to maintain compliance with CPAP, sleeping in bed.

1) Restless Leg Syndrome (RLS)
2) Often, my nerves don’t let me lay down, I have to sleep sitting up. I have no other choice but to sleep on the couch.
3) Doesn’t help show compliance when I do use the machine that the mask comes off after an hour or so. I’ve learned to put on a chin strap which really has helped.

So, my question to you all is, “What to do, what to do”?

https://imgur.com/JCMDR45

So use the machine on the couch.

palerider wrote: ↑

Sun May 28, 2023 11:19 pm

So use the machine on the couch.

What he said.

Honestly, I never quite thought of that. I could try that and see how it goes.

Also, how long does big brother monitor? Please don't say forever and ever amen!

I started cpap in April of 2010.
My sleep doc downloads a month or three once a year, per Medicare requirements.

Are you being treated for RLS? There are drugs that help. Results vary.

Starlette wrote: ↑

Mon May 29, 2023 1:30 am

Also, how long does big brother monitor? Please don't say forever and ever amen!

It depends on which insurance company you are using and what is the "compliance" trying to prove.
It is to prove compliance so that a recently received new machine will be paid for by the insurance company per whatever contract they have or is it proving "compliance" to get masks and other supplies.

If you have Medicare (or some other insurance company that goes by Medicare guidelines) and you just got a new machine not long ago...
Medicare compliance requirements for machine use is
70% of 30 consecutive nights (within a 24 hour period so doesn't necessarily have to be a consecutive 4 hours)with at least 4 hours of machine use. You don't have to be asleep either. They won't know if you are awake or asleep. Use it while awake and watching TV or reading a book if you are borderline meeting that 4 hour requirement.
So 21 nights out of 30 consecutive nights and once that is satisfied Medicare doesn't care and will pay for the machine.

If you don't have Medicare you will need to contact your insurance company and find out exactly what their compliance requirements are.

If the DME is well run, they would want you to be compliant. It's in their interest to get paid for the machine rather than to have to repossess it and have a used machine on their hands.

How about supplies that a DME provides for a CPAP that they submit a bill to Medicare/Insurance? Does the DME need to verify usage/compliance for them to submit a bill for payment? I've kinda wondered about this as I sometimes switch off my primary CPAP for a length of time to an alternate one the DME has no record of and can't access the data.

Very good question Grumpy48

Grumpy48 wrote: ↑

Thu Jun 01, 2023 5:03 pm

How about supplies that a DME provides for a CPAP that they submit a bill to Medicare/Insurance? Does the DME need to verify usage/compliance for them to submit a bill for payment?

No. But if insurance asks for compliance records and the insured can't provide them, the claim will be rejected.

Many DMEs have their own policy to require up-to-date compliance data to avoid this situation. For example, once per year, my DME requires the data and a statement from my doctor that I use CPAP and benefit from it. This helps the DME and me avoid rejected claims.