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Both of you, you and your doctor, seem to be missing the point.... Compliance is ONLY is a number set as the MINIMUM that they use to decide if they are going to continue paying their part on your XPAP. Below that level they are suppose too stop paying and take the XPAP back. It's NOT a GOAL, that will make you better.

The GOAL that will help you is to USE XPAP correctly every time you sleep for the rest of your life. In the beginning it takes commitment on your part, as you really commit it gets easier. It's past time to start making your life better. Jim

What happens after you get past the compliance period and they have paid for the device? BCBS has paid, but, how do they confirm that you still use it regularly? I am hooked in with ResMed Myair, but, how do they know this? They are still paying for my supplies. How do they confirm my continued compliance?

SunnyBeBe wrote:What happens after you get past the compliance period and they have paid for the device? BCBS has paid, but, how do they confirm that you still use it regularly? I am hooked in with ResMed Myair, but, how do they know this? They are still paying for my supplies. How do they confirm my continued compliance?

Did they take back the modem? If not, they still have the capacity to check compliance. Whether or not they exercise that capacity is another question.

I was a little annoyed that I needed to prove compliance even though I have been using CPAP for seventeen years.

After 11 years Lincare called me to check if I was using my XPAP, once in 11 years...

My doctor provides them with papers saying my use, guess his girl forgot, I wasn't aware of the need at all, stupid system Jim

D.H. wrote:

SunnyBeBe wrote:What happens after you get past the compliance period and they have paid for the device? BCBS has paid, but, how do they confirm that you still use it regularly? I am hooked in with ResMed Myair, but, how do they know this? They are still paying for my supplies. How do they confirm my continued compliance?

Did they take back the modem? If not, they still have the capacity to check compliance. Whether or not they exercise that capacity is another question.

I was a little annoyed that I needed to prove compliance even though I have been using CPAP for seventeen years.

I'm not sure what you mean. I know that initially, during my probation period, the provider company monitored me during my compliance period. Not sure if they still do. If no one is paying them to do it, I doubt they are. I can't recall if they did it remotely or I took them my SD card.

SunnyBeBe wrote:What happens after you get past the compliance period and they have paid for the device? BCBS has paid, but, how do they confirm that you still use it regularly?

No one may even care once initial compliance has been made. It all depends on the insurance and what it requires and even within BCBS there are any number of different plans that may or may not have the same requirements.
If they require something then the DME has to get it...usually by downloading the SD card but if a person has one of the newer machines with the cellular data transmission they can access whatever is transmitted (assuming someone hasn't put the machine in airplane mode).

I have never had to prove any sort of compliance...not for the machine because I bought privately.
Not for masks either.
Been 8 years now and haven't see the doc in almost 8 years now...and DME doesn't even know which machine I am using and doesn't care.
Medicare gets me a new mask setup up every 6 months and I pay 20% of Medicare's allowable amount (usually around $30 is my portion)...and that is all there is to it. I have never had to prove any use at all to my DME to get anything.

So far, I haven't had to prove anything outside the initial compliance period, but, you never know. I'm okay with it. I suspect that I am in the top 5% of people who use their cpap machine....maybe more. I'm not sure.

Here's a study from 2008. I hope that the numbers have improved since then.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2679572/

My doctor told me they report compliance to my insurance company just in case.
After my 2-year follow up he said I don't even need to see him anymore - the only reason would be if I needed insurance validation or if I started having problems.
Then my insurance plan changed and the deductible for DME supplies went way up so I stopped buying filters and such from the DME anyway.
I'll probably go in for another follow up whenever it's time for a new machine... three years on this one and it's working fine.