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Wife did not pass compliance
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mjbearit Offline

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Machine: REMstar Auto AFlex DS550
Mask Type: Nasal pillows
Mask Make & Model: RESMed Swift FX
Humidifier: Heated humidifier - 2
CPAP Pressure: 12.5-20
CPAP Software: SleepyHead EncoreBasic

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Sex: Male
Location: So Cal

Post: #11
RE: Wife did not pass compliance
Looks like they got the wrong data matched up with the wrong patient. I would definitely fight this! A lot of folks let these things go, but you pay your premiums and your co-pays and whatever, they need to hold up their end of the deal also! You need value for your premiums! Talk to the DME and the Doc. Take a print out of what you have above and show them! I would also write a letter to the INS company and include that data. If you lay down they will roll you over. Don't let them get away with it.

As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
06-24-2012 11:51 AM
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ScottBerglin Offline

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Machine: Respironics System One Auto A-Flex
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: Remstar Heated Humidifier
CPAP Pressure: 9 - 14
CPAP Software: SleepyHead

Other Comments: APAP since 8/2/2010, AHI average/yr = 2.10

Sex: Male
Location: Lake Forest Park, WA

Post: #12
RE: Wife did not pass compliance
(06-24-2012 11:51 AM)mjbearit Wrote:  If you lay down they will roll you over. Don't let them get away with it.

Right on! This is standard operating procedure for insurance companies. We all know that. All of us also know that it takes awhile to get used to CPAP, to find the right equipment, etc. If the policies of DME's acknowledge this learning period, then the policies of insurance companies have to acknowledge it also. Get in their face.

--==<< old, experienced, but still curious >>==--
06-24-2012 12:27 PM
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archangle Offline
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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: #13
RE: Wife did not pass compliance
Go to the DME, make them open up your data with ResScan in front of you. Show this to them.

The DME is probably the one who generated the wrong data report in the first place. Getting them to write the insurance company stating that their earlier information filed with insurance was wrong.

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.
(This post was last modified: 06-25-2012 02:58 AM by archangle.)
06-25-2012 02:57 AM
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w7sot Offline

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Machine: Resmet S9 auto
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Other Comments: EVO Medical ComfortFit Full Face Mask

Sex: Male
Location: Springfield, OR

Post: #14
RE: Wife did not pass compliance
(06-25-2012 02:57 AM)archangle Wrote:  Go to the DME, make them open up your data with ResScan in front of you. Show this to them.

The DME is probably the one who generated the wrong data report in the first place. Getting them to write the insurance company stating that their earlier information filed with insurance was wrong.

So I called the DME today, to see if their was anyone their that could explain to me how they got the numbers they did - was told I have to talk with one of the RT's - and they are out of the office all day, so have an appointment tomorrow to sit down, and see how they get their 61% - will take in the card, the printouts in Rescan - and figure out they come up with their numbers. once we get this figure out, we are going to switching DME's, and the plan is to get my wife on a full data machine to figure out what is going on.
06-25-2012 04:36 PM
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archangle Offline
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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: #15
RE: Wife did not pass compliance
(06-25-2012 04:36 PM)w7sot Wrote:  So I called the DME today, to see if their was anyone their that could explain to me how they got the numbers they did - was told I have to talk with one of the RT's - and they are out of the office all day, so have an appointment tomorrow to sit down, and see how they get their 61% - will take in the card, the printouts in Rescan - and figure out they come up with their numbers. once we get this figure out, we are going to switching DME's, and the plan is to get my wife on a full data machine to figure out what is going on.

Take good notes. Make them show you where they got the data.

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.
06-25-2012 06:34 PM
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w7sot Offline

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Posts: 35
Joined: May 2012

Machine: Resmet S9 auto
Mask Type: Full face mask
Mask Make & Model:
Humidifier: resmed H5i
CPAP Pressure: 10-18
CPAP Software: ResScan SleepyHead

Other Comments: EVO Medical ComfortFit Full Face Mask

Sex: Male
Location: Springfield, OR

Post: #16
RE: Wife did not pass compliance
(06-25-2012 06:34 PM)archangle Wrote:  
(06-25-2012 04:36 PM)w7sot Wrote:  So I called the DME today, to see if their was anyone their that could explain to me how they got the numbers they did - was told I have to talk with one of the RT's - and they are out of the office all day, so have an appointment tomorrow to sit down, and see how they get their 61% - will take in the card, the printouts in Rescan - and figure out they come up with their numbers. once we get this figure out, we are going to switching DME's, and the plan is to get my wife on a full data machine to figure out what is going on.

Take good notes. Make them show you where they got the data.

LOL - that was the funny part - they COULD NOT show me anywhere where they had read the card with the 61% - according to them, they had read the card a total of three times - and every showed over 80% compliance - but according to them, she should have had one more time of reading the card by this time - so she should have had 4 different reports - that that missing one must be the 61% one!!! - ok, so the thing is - we took the card in after the first month to have it read. 4 weeks later I went back down to the office, to get another card becuse they never sent the original back - and the read the second card for the first time today - they should have had only 2 reports!!! - so how did they come up with the third one - and they have yet to explain the 66% - they resubmiting things to insurance - and then I had to make them send in the report that showed a full 30-days, and 81% compliant - that is all the need to be happy - they don't need a compliance report EVERY MONTH - they only want ONE in the first 90 days of having the machine, showing that is was used for 70% of the time in any 30-day period - vey very soon, we are going to be dropping them - unfortunately, their is no way to do anything about the brick she hased to use.
06-26-2012 05:34 PM
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archangle Offline
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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: #17
RE: Wife did not pass compliance
(06-26-2012 05:34 PM)w7sot Wrote:  I had to make them send in the report that showed a full 30-days, and 81% compliant - that is all the need to be happy - they don't need a compliance report EVERY MONTH - they only want ONE in the first 90 days of having the machine, showing that is was used for 70% of the time in any 30-day period - vey very soon, we are going to be dropping them - unfortunately, their is no way to do anything about the brick she hased to use.

Is the gist that they're going to tell the insurance company your wife is compliant?

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.
06-28-2012 12:34 AM
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