What is normal compliance hours for rented machine?

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mzlaura1884
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Joined: Mon Jul 30, 2012 7:04 pm
Location: New Hampshire

What is normal compliance hours for rented machine?

Post by mzlaura1884 » Thu Aug 23, 2012 1:46 pm

I forgot =( they originally sold the machine to me then wanted to rent it. How many hours do i have to use to meet the compliance in one month?

I have UHC ppo. Didn't know if anyone had any idea?

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Pugsy
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Location: Missouri, USA

Re: What is normal compliance hours for rented machine?

Post by Pugsy » Thu Aug 23, 2012 2:00 pm

You would need to check directly with your insurance company to find out for sure but I think usually 4 hours a night for 70% of the number of nights in a month or whatever time period they are monitoring.

8 hours one night and not using the machine the next night...only counts for 1 night using it though.. Can't add up the hours to make up for nights off the machine or less than 4 hours a night.

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purple
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Re: What is normal compliance hours for rented machine?

Post by purple » Thu Aug 23, 2012 2:08 pm

Who is the "They"

With Medicare, which other insurers sometimes emulate their policy, one is said to get a machine, and we use the term that Medicare paid for it. The real deal, for Medicare, is that the machine is on a 13 month rental, at the end of which we own our machine, ourselves. At several times, Medicare demands that we have compliance. We are using the machine so much, we continue to see the doc responsible for the machine.

Like, if the doc changes the settings on the machine, then we must have a return visit for the doc (whomever is acting as our sleep doc) to make sure our treatment is progressing.

Newcomers should keep in mind that if they get a machine through insurance, if the individual compliance thresholds are not met (use so many hours a day/a week) then the insurance company might stop paying for the month to month rental. Then we might legally be on the hook to pay for the machine, or perhaps return it. The warning being that if an individual gets a machine and decides they are going to do the treatment no way no how, and they sell, give away, trade, throw away the machine, then the individual might find themselves responsible to pay for that machine. The machine does not belong to individual until the rental period is over.

If one is supposed to see one's sleep doc, (Medicare) and do not, then Medicare will stop paying for supplies, like masks, hoses, filters.

Other potential aggravations: I wanted a different type of machine, (a Bi-Level) than the one I have. If I get the machine from my DME, given that Medicare may choose to decide I do not need the machine, the DME requires that I agree to pay the entire price for the machine. I can not find out if Medicare will pay their 80 percent until after I have the machine in hand. Insofar as I know, if I wanted to appeal the decision made by Medicare, I do not know of a way to do that.

I think other insurance companies have equally aggravating policies. Then we can talk of the DME being aggravating.