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Surprise visit from insurance company
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brianwood619 Offline

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Post: #1
Surprise visit from insurance company
Well thank goodness for data, and for the members of this forum to encourage me to get a data recording machineThanks. A very nice lady from our insurance company stopped yesterday afternoon and wanted to see the data cards out of my cpap and my sons bipap machines. We both showed 100% compliance. She said the insurance company is purchasing these machines and some folks are using them a few times and then not using them at all. She said she was surprised to see we both religiously use ours (considering my son is 17). She said most kids dont hang with it all that long. i told her my son didn't need much coaxing after we all spoke to him after his sleep study. I understand why they are spot checking considering between the both of us we have around $3,000.00 in machines and equipment. She also said this would be the last time we would see her, the way she looks at it if we do it 100% of the time then we are not one of the "short-timers".

Food for thought, dont know if anyone elses insurance would do that but i'm not complaining considering they ate the complete cost of sleep studies and machines for both me and my son.
05-01-2014 08:35 AM
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PollCat Offline
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Post: #2
RE: Surprise visit from insurance company
Good for you and your son! Well-done

I wonder if your insurance company is going to start a trend? From their point of view, spot checking compliance makes a lot of sense. On the other side of the argument, I can see insurance companies requiring sleep apnea suffers getting data machines and not "bricks".


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.
05-01-2014 08:55 AM
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brianwood619 Offline

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Posts: 171
Joined: Jan 2014

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
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CPAP Software: ResScan SleepyHead

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Location: Peaceful Acres

Post: #3
RE: Surprise visit from insurance company
Pollcat oddly enough when i got the S9 escape and then called back to the insurance company to see if I could get the elite, they were like, you should have gotten the elite from the start....oh well DME blues I guess....lol
05-01-2014 09:08 AM
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Doc J Offline

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Post: #4
RE: Surprise visit from insurance company
That's a good story but I am distracted by my laughing at your animated avatar, very nice. I'm glad your in the group of people who know they need pap and are willing to use it. I'm with you on that one. Way to show that lady what 100% looks like.
Doc J
05-01-2014 09:18 AM
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brianwood619 Offline

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Machine: ResMed S9 VPAP Auto
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CPAP Software: ResScan SleepyHead

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Post: #5
RE: Surprise visit from insurance company
Well Doc J im in the middle of year three of pap therapy, I dont want to go back to what i call the zombie zone, which is what i felt like prior to pap therapy. I'm happy my son is doing his thing with it, with the exception of one wrestling trip where he forgot to take it with him, he on his own packs it with him everywhere he goes without prompting from his mother or me. Carter's stamina in wretling seems to have increased dramatically with getting full nights sleep. Its hilarious on Saturday mornings when he sleeps in, from going to sleep to waking up he's on therapy for around eleven hours. We know when he gets up because we hear him upstairs running to the bathroom to pee, apparently before pap therapy he was getting up five times a night to use the bathroom. Those days are gone for both of us!!
05-01-2014 09:42 AM
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glfredrick Offline

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Post: #6
RE: Surprise visit from insurance company
Not bragging or anything, but I had similar experiences early on before I divorced my sleep doctor and assumed control of my own apnea needs. I had to submit my card for monthly scans at a horrendous price (I just finished paying off the collections department $1100 still left on my account from 7 years ago and I've been paying all along!). Upshot was, they were shocked at the number of hours I recorded. I started at 5.5 a night on average and held that number for 3-4 years (that was literally all the time I spent in bed). I'm now up to 6.7 -- getting lazy in my old age, I guess. But, over 7+ years of sleep treatment, I've only missed 3 nights and probably had to pull the mask off another 4-5 times short of a full night for other reasons like illness.
05-01-2014 02:35 PM
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zonk Offline

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Post: #7
RE: Surprise visit from insurance company
(05-01-2014 08:55 AM)PollCat Wrote:  On the other side of the argument, I can see insurance companies requiring sleep apnea suffers getting data machines and not "bricks".
If all to do with compliance data, you can get compliance data from any brick

As for spot check, I've not heard it before (is it something to do with Obama care), thought compliance check done by the DME or wireless modem attached to your machine

Sound fishy to me, did you check her ID but suppose its the shape of things to come, CPAP police knocking on your door in the middle of the night Coffee
05-01-2014 03:14 PM
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brianwood619 Offline

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Machine: ResMed S9 VPAP Auto
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CPAP Pressure: 16-22cm/h2o
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Peaceful Acres

Post: #8
RE: Surprise visit from insurance company
Yep she provided credentials, I should have noted this earlier, the CPAP thing was not the only reason she visited. She asked if there were any other problems if everyone was able to get in to see a Primary care provide and so on. After ten years of working part time for a flight company I went full time last September and switched to the company sponsored insurance. For the first time in twenty four years of being in the work force this is the first insurance company that seems to go out of its way to make sure the customers are taken care of.
05-01-2014 05:19 PM
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justMongo Offline

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Post: #9
RE: Surprise visit from insurance company
It's odd to me too. I think I would have asked for a warrant.
(While racking a shell in my 12 gauge.)

Unless your on some kind of home care; they have no right to show up at your door and expect entry.

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.
05-02-2014 08:37 AM
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PaulaO2 Offline
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Post: #10
RE: Surprise visit from insurance company
Yeah, while I'm kinda glad they are being proactive, actually doing their own work and not leaving it up to the DME, it is rather creepy they were actually at your door. What would she have done if you weren't being compliant? Did she have the power to do anything or was she just shooting blanks?

PaulaO2
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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.
05-03-2014 01:29 AM
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