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Can you regain CPAP coverage after failing compliance the first time?
#1
Can you regain CPAP coverage after failing compliance the first time?
If you were prescribed a CPAP machine for sleep apnea but couldn't meet the compliance requirements during the first 90 days, resulting in the machine being taken away, is it possible to try again and have the machine covered by insurance? If so, how would this process work?
I'm asking because I'm concerned about potentially losing coverage if I don't meet the initial compliance period - I have alot of other health issues that is preventing me to use the CPAP for periods at a time. I'd like to know if there's a way to start over and regain coverage should this happen.
Any insights or experiences from the community would be greatly appreciated. Thanks in advance!
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#2
RE: Can you regain CPAP coverage after failing compliance the first time?
My recommendation would be to take matters into your own hands. Browse the supplier list for deals on an AirSense 10 Card-to-Cloud, they used to be $350-400 out of pocket if you have a prescription already, but prices seem to be going up a bit. Then it's all up to you from there. For example, I benched mine for about 80% of nights the past few months since I had my nasal surgery, and not a single medical provider has squawked at me since it's my machine to use at my discretion. The peace of mind knowing that it's your machine to use as you feel best without the fear of losing it will help you get the best treatment from it.
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
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#3
RE: Can you regain CPAP coverage after failing compliance the first time?
I failed compliance on the 1st machine that I was issued after my polysomnography - the ST (A).  I called my DME when I knew that I was going to fail to see what my options were to get an idea.  Not much info given to me at that point.  After failing, I was issued a different sleep test (capnography or "cap/ox") and failed it and qualified for a ventilator.  Also, people with more complex and more severe apnea usually need to fail their 1st machine to be able to get promoted to a more capable machine also.  

It wouldn't hurt to call your DME and/or PCP and tell them your situation to find out your options.  Wouldn't hurt.  You can decide how to proceed based on their info.  Great plan outlined by Pete also.
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#4
RE: Can you regain CPAP coverage after failing compliance the first time?
depending on where you are, you can find good deals on very lightly used machines. or as mentioned, look for new ones on sale. i haven't relied on a dme to get cpap gear for years.

it's all available online.
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#5
RE: Can you regain CPAP coverage after failing compliance the first time?
Thanks so much everyone for the suggestions and help, really appreciate everything.  I'm thinking now maybe its not worth all this hassle and just buy a used machine straight out....will make my mental stress easier than dealing with insurance.  Thanks again!!!
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#6
RE: Can you regain CPAP coverage after failing compliance the first time?
Instead of buying a used one, buy a new card to-cloud. Then it will be new, and all yours. Without a DME, you wouldn’t need the modem function. You’d still need a prescription, but your PCP could write one.

If you’re on Medicare, there is indeed a way to re-qualify. Contact the DME.
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