Basically it comes down to a few things
1) federal laws
2) state laws
3) what you sign
Every ins co gets SOME part if your medical conditions. Diagnostic codes , etc that's when a dr puts down like 889.2 etc meaning you were diagnosed with X condition. So yes they know what yiu are diagnosed with, and any surgeries / equipment they pay for. Beyond that, they get NOTHING unless they deny a claim or request further tests, or further proof you need xyz medication , surgery or procedure, or equipment. They may request all medical recordS RELATED to that condition, but NEVER an A to Z copy of your history.
That's IT. they can't get more unless you SIGN. Something. With the new ACA healthcare act , they can no longer request medical history to see if you are lying about pre existing because they now MUST accept you when u apply regardless. They can't even ask u your history except smoking, drinking, etc. Even that can't raise your rates (unless you have like insurance fraud on record)
So yes , in some states, bcbs may req you to sign a form giving them access too your data because if you don't use the machine at least 4-5 nights for at least 4-5 hrs, they stop paying for new supplies until u can prove u are back in compliance.
But my point was: YOU MUST SIGN SOMETHING. If you don't, like here in NC, ins cos don't req compliance data (mist don't) The only ppl that see my data is healthy @ home,my dr, and his nurses. No billing dept ever sees my data. Billing in other areas just see diagnostic codes to bill an ins co. That's all billing should EVER see:codes, equipment , RXs, procedures NOT records and not data in detail.
Someone was correct and I was wrong about the modem it says Rx only but the tech lied to me cuz they overrode and re locked the system remotely (which I just unlocked). Then I called and bitched them out. Then they said they'd stop, but they'd have to report it to the Dr (whom I already told I unlocked it). He was ok with it as long as I kept the max at 18-20. The machine never even hits 14. It's set to 20 max, 11min. Start at 4, ramp I set 10, 20, or, 45 min depending on how sleepy I am.
As far as changing it. The laws in any state only require an Rx to get a cpap, mask, or humidifier, battery backup. Accessories do not need an RX (heated tubes, padding etc) and can be bought online. I got my dr to send my Rx to Supplier #1
. This was I can buy higher quality masks , tubes, etc that my ins doesn't pay for. Anyway to change pressure/settings , a tech, clinician needs an Rx in some states or an order. Don't get a battery backup!! Get a 100-300$ apc ups that does 1500-2250Va. It could run your cpap for about 4-6 times for 8hrs. They also sell 12v 500amp car batteries with 110-120v plug ins that can charge devices or run ur cpap for ages. Most ins cos will not pay the 700$ for a cpap battery that lasts only 10hrs unless u can prove ur power goes out A LOT.
Regarding the patient : YOU CAN DO WHATEVER YOU WANT WITH THE SETTINGS. No state or federal law exists anywhere prohibiting you to do so, nor are there penalties. It's like getting a bottle of 30 painkillers that say take 1 a day. If u take 2, do u break a law nope. It's yours. If u take all 30 and kill yourself. That's your issue. U are trusted to manage ur Rx ur own. Same applies to a cpap. You are trusted if your pressure is 15-20 that u don't set it at 4-8 where it's useless.
What that said. SOME DRs and companies may make you sign something (on rented and leased stuff) that if u mess with it, they take it back. Even that's rare. What? They take away something that you could die without having? (Central apnea is deadly). But still , if u signed something, then DONT mess with it.
However, if u OWN IT. By that I mean your ins outright paid for it, or you did, *****Then NO ONE can stop you or penalize you for changing it*****. It may upset your Dr and he could drop u as a patient. But the machine is still yours and u can go find another Dr who doesn't have a stick up his a**
Why would I change it? I USE it! Not the techs or DRs. They see numbers. I see the numbers but I FEEL how well it works. I've fine tuned mine so my masks don't blow off and I got my total ahi, central ai, and total ai scores all under an avg of 1 in any given time period. They were 15+ under my DRs orders. They changed them 3Xs. Every time I was miserable. So I went online and there a few sites they tell u how to unlock EVERY cpap, APAP, and BPAP/vpap in existence.
I'm not saying everyone should mess with their cpap, I'm saying there's no law in existence to stop you.. And what ppl can and can't see about your medical history unless u give WRITTEN permission
In fact, the OWNER of this site is how I figured things out. Just go to the main web adress then how to change apnea settings. He dares anyone to find laws against it. Then I did my own research to find there are none