Hope you guys can help me here. I've looked for an answer, but all I seem to get is that the compliance period falls within the first 90 days of use.
My insurance is Medicare, and I was diagnosed with OSA in late May of 2018, and prescribed for, and had shipped to me an Airsense 10 Autoset, and an AirFit F20 face mask. Started using it June 6th, and minus a few bumps in the road, everything had gone very well. Saw my ENT within 90 days....he confirmed it was helping me, and that was that. But in November I started having some other health issues that ultimately landed me in the hospital. I have recovered ok, but since then I am having a LOT of trouble sleeping even more than an hour a night, and as a result, my usage of the APAP has dramatically decreased. I didn't think anything about compliance, since I was way past the 90 day period. I just received a phone call from my ENT's office, saying they received a letter from my insurance, asking for me to come in to the office next week. She wouldn't give me any more info than that. Am I right in assuming that they still monitor usage well beyond the compliance period? Sounds like they want an assurance that I am still using the machine, or that they will pull the plug.
Any input would be greatly appreciated.
Compliance after a successful 90 days?
- Okie bipap
- Posts: 3566
- Joined: Thu Oct 15, 2015 4:14 pm
- Location: Central Oklahoma
Re: Compliance after a successful 90 days?
Do you have basic Medicare, or do you have something else? Medicare only requires you to use your machine for at least 4 hours a night for 21 out of 30 days. This must be verified by your doctor or DME within 90 days of starting treatment. I fulfilled my compliance requirement within the first 30 days and that was it. If you have a Medicare advantage plan, then you are at the mercy of your insurance carrier. They set the ground rules, not Medicare.
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Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Mask: Evora Full Face Mask - Fitpack |
Additional Comments: IPAP 20-25, ps 4, OSCAR software |
Growing old is mandatory, but growing up is optional.
Re: Compliance after a successful 90 days?
Thanks for the reply, Okie. I have original Medicare. I'm just a little concerned as to why I have see the ENT again....as he told me I wouldn't have to return after the 90 day compliance visit. The fact that this "letter" coincides with a period of almost a month where the machine was used very sporadically, has me a bit worried. I certainly want to use the APAP again with success I had before, but I'm literally unable to sleep more than an hour a night. I guess I'll see what the deal is this Wednesday.
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Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: ResMed AirFit™ F20 Full Face CPAP Mask with Headgear |