Post Reply 
Insurance compliance question
Author Message
vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #21
RE: Insurance compliance question
(09-05-2012 02:44 PM)jodiramm Wrote:  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".

This means you will be in compliance if you have used the machine for at least 4 hrs per night (I think all time is counted while machine is delivering pressure, including time when awake), for any 42 nights during the 60 day period. (42 days is 70% of 60 days.)

I think some insurance companies may require 4 hrs and 45 minutes miminum use during a night, for the night to count.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
09-15-2012 09:12 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Bernie Offline

Preferred Members

Posts: 23
Joined: Aug 2012

Machine: Resmed Autoset Spirit, ResMed S9 autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift LT
Humidifier: ResMed H5i
CPAP Pressure: 7-15
CPAP Software: ResScan SleepyHead Other Software

Other Comments:

Sex: Male
Location: Texas

Post: #22
RE: Insurance compliance question
(09-06-2012 09:49 AM)jodiramm Wrote:  Thank you archangle. What you wrote was very helpful. I appreciate every word.



This has been a very informative thread. My sleep doctor prescribed a fixed pressure, but upon my insistence, he did specify the S9 autoset. My provider first supplied a Resmed CPAP unit but I refused it and insisted on the S9 autoset. They ordered the S9 autoset after I wrote them a $250 check for the price difference. They said that they had reported the unit to Medicare as a CPAP, to keep the Medicare records straight.

Anyway, I've used the S9 autoset for over a month now but they have not asked for the SD data card and they have not contacted me about getting compliance data.

Does anyone have current information on the Medicare requirements for compliance and for granting me final ownership?
09-18-2012 07:27 PM
Find all posts by this user Post Reply Quote this message in a reply
archangle Offline
Wiki Editor
Advisory Members

Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #23
RE: Insurance compliance question
(09-18-2012 07:27 PM)Bernie Wrote:  [font=Times New Roman][size=medium]
This has been a very informative thread. My sleep doctor prescribed a fixed pressure, but upon my insistence, he did specify the S9 autoset. My provider first supplied a Resmed CPAP unit but I refused it and insisted on the S9 autoset. They ordered the S9 autoset after I wrote them a $250 check for the price difference. They said that they had reported the unit to Medicare as a CPAP, to keep the Medicare records straight.

Anyway, I've used the S9 autoset for over a month now but they have not asked for the SD data card and they have not contacted me about getting compliance data.

Billing you extra for the AutoSet probably violates their contract with Medicare and is probably a federal crime, especially if they billed Medicare for the machine. Usually, APAPs and CPAPs are billed under the same code for insurance, and the DME is required to accept a fixed fee for the machine, no matter which CPAP it is.

It was probably illegal to try to dispense anything other than the AutoSet if the doctor wrote "Dispense as written."

However, they could probably have refused to dispense an AutoSet, unless the prescription specified a pressure range.

Your call as to whether you made an honest deal with them and whether to pursue the issue.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
09-18-2012 09:57 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  REMStar SE with DOT Compliance musicman85 11 398 12-01-2016 09:08 PM
Last Post: musicman85
  Insurance won't pay for power cord? CharlotteYork 13 901 11-17-2016 11:58 PM
Last Post: tzk321
Sad Help Finding A Machine, No Insurance SJGino 23 789 11-17-2016 09:03 PM
Last Post: SJGino
Angry INSURANCE RECORDS: DO YOU REALLY WANT TO KNOW? srlevine1 5 556 11-15-2016 06:31 PM
Last Post: Galactus
  [CPAP] Insurance / Getting first CPAP rjbbjr 14 628 11-11-2016 01:06 PM
Last Post: Mosquitobait
  Insurance woes: Who has my "compliance" and "post pap" documentation? luminous 8 1,295 08-15-2016 12:09 AM
Last Post: SaldusMiegas
  ASV and Insurance Question rozenbob 15 716 08-06-2016 08:43 PM
Last Post: DeepBreathing

Forum Jump:

Who's Online (Complete List)