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Insurance compliance question
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jodiramm Offline

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Joined: Aug 2012

Machine: S9 Resmed Elite
Mask Type: Nasal pillows
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CPAP Pressure: 9
CPAP Software: Not using software

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Sex: Female
Location: Illinois

Post: #1
Insurance compliance question
Hello Everyone! I have to ask a question that may be kind of silly. I struggle with insomnia and i have now been with the CPAP for a month now and have slept under 4 hours 3 times in this amount of time and the compliance is that for 2 months i use the machine 70% of the time, and i was told that meant at least 4 hours a night. Oh boy, i guess that means i better make sure i stay in bed hooked up this next month for 4 hours no matter what?
09-05-2012 08:09 AM
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PaulaO2 Offline
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Posts: 8,067
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
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CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #2
RE: Insurance compliance question
You answered your own question.

Insurance compliance is rarely, if ever, flexible.

You could ask for an extension now, before it is too late.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
09-05-2012 09:31 AM
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JudgeMental Offline

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Posts: 324
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Machine: Respironics DreamStation Auto-CPAP
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CPAP Pressure: 11-14
CPAP Software: SleepyHead

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Sex: Male
Location: Florida USA

Post: #3
RE: Insurance compliance question
Welcome..my lazy mans math tellsl me that you have 6 days left of your 70% requirement toward compliance. It appears to me that as Paula has suggested, (ask for extension or discuss this w/ doctor) or you dedicate your efforts to stay on the mask for a longer period of time. If you stay on the mask longer and sleep better then perhaps the insomnia will begin to fade or ease. Good Luck

Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
09-05-2012 10:08 AM
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big_dave Online

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Machine: PR System One DS560
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Mask Make & Model: F&P Pilairo Q or ResMed Mirage Activa
Humidifier: PR System One
CPAP Pressure: 14 - 20
CPAP Software: SleepyHead

Other Comments: Former ResMed S8 Autoset II user

Sex: Male
Location: Eugene, Oregon

Post: #4
RE: Insurance compliance question
Are you saying that you used your machine for less than 4 hours for three nights, and more than 4 hours for the rest of the month? That is 90% compliance. It sounds like you are doing well.

If all else fails, you can use your machine while reading or watching TV. The machine can't tell if you're asleep or awake, and this helps for getting used to the machine.
09-05-2012 10:14 AM
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JudgeMental Offline

Advisory Members

Posts: 324
Joined: Feb 2012

Machine: Respironics DreamStation Auto-CPAP
Mask Type: Full face mask
Mask Make & Model: Respironics Amara View
Humidifier: Respironics
CPAP Pressure: 11-14
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Florida USA

Post: #5
RE: Insurance compliance question
I knew I shouldn't have skipped math class that day. Dielaughing

Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
09-05-2012 11:11 AM
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jodiramm Offline

Members

Posts: 18
Joined: Aug 2012

Machine: S9 Resmed Elite
Mask Type: Nasal pillows
Mask Make & Model:
Humidifier: Resmed H5I
CPAP Pressure: 9
CPAP Software: Not using software

Other Comments:

Sex: Female
Location: Illinois

Post: #6
RE: Insurance compliance question
Thank you all so much! My math is horrible, but i did indeed just get in the rest of my time reading to get my 4 hours in. I am just going to be extra careful for now on.
09-05-2012 11:55 AM
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PaulaO2 Offline
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Moderators

Posts: 8,067
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #7
RE: Insurance compliance question
Just for general information, do they actually want 4 hours each night or just a certain total amount of hours during the 2 month 'trial'? So, say, in 60 days, an average of 8 hrs a night (math ain't my thing either!) that'd be 480 hrs total. So you need 70% of that? But with that equation, 4 hrs a night would be 50%....

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
09-05-2012 12:53 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,067
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #8
RE: Insurance compliance question
Meanwhile, discuss with the sleep doc about your insomnia issues.

Google 'sleep hygiene' as well. I've had insomnia for, like, nearly all of my life. I've even taken sleep hygiene classes and had sleep counseling.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
09-05-2012 12:54 PM
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PollCat Offline
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Posts: 1,576
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Machine: ResMed S9 Autoset
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CPAP Pressure: 10 - 18
CPAP Software: SleepyHead

Other Comments: CPAP-ing since 1995; Type 2 Diabetes; Chronic Asthma; Gout

Sex: Male
Location: Westfield, IN

Post: #9
RE: Insurance compliance question
(09-05-2012 12:54 PM)PaulaO2 Wrote:  I've had insomnia for, like, nearly all of my life.

Well, that certainly explains your strange pattern for being on the forums at odd times during the night! Bigwink


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.
INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
09-05-2012 01:47 PM
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jodiramm Offline

Members

Posts: 18
Joined: Aug 2012

Machine: S9 Resmed Elite
Mask Type: Nasal pillows
Mask Make & Model:
Humidifier: Resmed H5I
CPAP Pressure: 9
CPAP Software: Not using software

Other Comments:

Sex: Female
Location: Illinois

Post: #10
RE: Insurance compliance question
When i picked up my equipment i had a form i had to sign and it stated that "if by the end of two months, you have used the CPAP at least 70% (equating to 4 hours per night), your insurance will reauthorize the unit for the additional rental period". At the end of the rental period, the people i got the equipment with will then convert the CPAP to a purchase and my insurance will no longer be billed. "If by the end of two months, you have not used the CPAP at least 70%, your insurance will not reauthorize the unit" and then i would either be billed for it or have to take it back to them.
09-05-2012 02:44 PM
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