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Insurance Compliance Problem - Printable Version

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Insurance Compliance Problem - fotomatt1 - 12-20-2016

So I received my DreamStation CPAP machine about a 6 weeks ago and had my follow up visit yesterday. My first week went well...I used the machine for 8 hours a night for 10 days straight. At that point, my wife gave birth to a baby boy and we've obviously been in and out of bed quite a bit. In addition to that, I've all of a sudden started taking my mask off in the middle of the night with no recollection of it. When I wake up the machine is off. Does it turn itself off automatically when it senses that you're not wearing it?

I was told that I'm only about 35% compliant, but I can still fix it in the next 6 weeks. Any tips? I really don't want to be billed in full for this machine. I'm really trying, but with my current circumstances (new baby at home) and business travel it's pretty difficult.


RE: Insurance Compliance Problem - justMongo - 12-20-2016

There is a feature called autostart that if enabled will start the flow when you mask up and take a breath. It also shuts down the machine if you remove the mask; based on the very high flow rate.

Some people do take the mask off unconsciously. You may be able to come up with some sort of creative solution to the mask removal -- short of handcuffs. If you do, please share it; as others have the same problem.

BTW -- congratulations to both of you on the birth of your son.


RE: Insurance Compliance Problem - OpalRose - 12-20-2016

The compliance requirement is set up by Medicare and most insurances and DME's follow this.

You have to meet compliance within the first 90 days of use.

You must use your cpap for a minimum of 4 hours a night for 70% of the time within a 30 day "consecutive" period. You have 90 days to do this.

Other compliance rules: You must see your doctor "after" the first 30 days of use and also must have a "face to face" doctor appointment "before" the 90 days is up.

Medicare used to post this on their site, but I haven't been able to find it.

You will have to find a way to get those 4 hours in. You can even sit and watch TV or read a book with mask and machine on.
(Ha,ha), I know its hard with a baby, but do whatever is necessary to meet the compliance.

Also, many people travel with their machine.


RE: Insurance Compliance Problem - Sleeprider - 12-20-2016

I think you got most of your answers above. I notice you're using Sleepyhead. You might take a look at your therapy breaks at night and look at the leak data just prior to the break. You should see a large leak about a minute or less in duration. If that is what is going on, you should use the menu to turn off the Auto-off feature. The clinical menu can be accessed by following this tutorial http://www.apneaboard.com/dreamstation-clinician-setup-instructions

Some people have used tape or additional security straps to cause them to arouse if they try to remove the mask. If the air doesn't shut-off someone is going to notice.


RE: Insurance Compliance Problem - Rcgop - 12-20-2016

Congratulations on the new born.
Travel with the cpap. I take mine everywhere, even on cruises. Cpaps do not count as carry on for any airline. I even think you can carry distilled water if you carry it openly.

Compliance - 4 one hour sessions count as compliance. I know that is not enough sleep but anything to be compliant. The machine does not lie or know any better.

Getting used to the mask is the most difficult. I heard mittens can help.


RE: Insurance Compliance Problem - fotomatt1 - 12-20-2016

(12-20-2016, 03:50 PM)Sleeprider Wrote: I think you got most of your answers above. I notice you're using Sleepyhead. You might take a look at your therapy breaks at night and look at the leak data just prior to the break. You should see a large leak about a minute or less in duration. If that is what is going on, you should use the menu to turn off the Auto-off feature. The clinical menu can be accessed by following this tutorial http://www.apneaboard.com/dreamstation-clinician-setup-instructions

Some people have used tape or additional security straps to cause them to arouse if they try to remove the mask. If the air doesn't shut-off someone is going to notice.

Thank you for this. If I shut off auto on/off my wife will wake up and yell at me. If I enter the clinical menu will they know? My machine has a cellular modem in it and they seem to know everything. I've been unplugging it during the day just because.



RE: Insurance Compliance Problem - Mosquitobait - 12-20-2016

(12-20-2016, 07:34 PM)fotomatt1 Wrote: Thank you for this. If I shut off auto on/off my wife will wake up and yell at me. If I enter the clinical menu will they know? My machine has a cellular modem in it and they seem to know everything. I've been unplugging it during the day just because.

They don't care. They only care that you are using it 4 hours a night.




RE: Insurance Compliance Problem - fotomatt1 - 12-20-2016

Thanks. So I just checked BD auto on is on and auto off is off. Now I'm really confused about how my machine is turning off.


RE: Insurance Compliance Problem - trish6hundred - 12-20-2016

Hi fotomatt1,
WELCOME! to the forum.!
Good luck to you with your CPAP and CONGRATULATIONS! on your new baby.



RE: Insurance Compliance Problem - DeepBreathing - 12-21-2016

It's quite possible you're turning the machine off yourself without being aware of it. Even after three years I do this sometimes, especially if there is a bad leak or something irritates me. It's just a matter of reach out and push the button, then whip the mask off and back to sleep. I don't worry about it too much, as SWMBO will usually give me a nudge, but then I don't need to worry about compliance. One suggestion I've seen (but not used personally) is to use a bit of surgical adhesive (eg micropore) to lightly tape the mask to your skin. Not enough to seal it (which I don't recommend) but enough to wake you if you pull it off.

Good luck, and congratulations on the new-borne.