Question for people being monitored by insurance

[Sasquatchswapgator]

I’m not happy how my machine is set up. I know how to get into the clinical settings but not sure if it would mess up getting insurance to pay. I have a follow up with my dr soon. My pressure is 10. I feel like it should be set to 10-20. Not stopping at 10. I plan on getting a sd card and monitoring it myself. Just not sure if there is much I can do with my machine being watched. They want me to use the my air app. That doesn’t seem like it’s works that well. Keeps showing no data. I rather monitor through Oscar. I have to be monitored for 3 months.

[LSAT]

Insurance doesn't care about your settings....they just want you to be using the machine they paid for.

[Sasquatchswapgator]

Insurance doesn't care about your settings....they just want you to be using the machine they paid for.

Thank you. I was told by the DME if I get into the clinical settings it would void the insurance paying for it. Didn’t think that was true but had to ask.

[greatunclebill]

After the patient starts CPAP treatment at home there has to be documentation of patient compliance. This is done after 31 days but before 90 days of usage. They must have a download of the CPAP usage and a face to face re-evaluation with their physician. Their physician must document that the patients symptoms have improved. Adherence to CPAP is defined as usage greater or equal to 4 hours per night on 70% of nights during a consecutive 30 days anytime during the first 3 months of initial usage.

every insurance is different but most follow medicare. I personally wouldn't mess with much without talking to the doc until you are certified.

[SleepGeek]

Thank you. I was told by the DME if I get into the clinical settings it would void the insurance paying for it. Didn’t think that was true but had to ask.

For some reason the DME's worry about us changing our settings not the insurance or even the doc prob doesn't. The DME also worries about hours of use so they can get paid. So you can disconnect the modem to see if the DME is watching but as long as the hours are on the machine you can prove it.

I took my modem right out and Apria tried to get me to pay them more than the insurance price but in court I proved I was using it more than 8hrs/day with my OSCAR reports and notes from my doc. Apria never contacted me to get any data.

[Pugsy]

I was told by the DME if I get into the clinical settings it would void the insurance paying for it. Didn’t think that was true but had to ask.

In case you didn't know....DMEs will lie when the truth would fit better.

Insurance companies don't care (don't even know) what your settings are or the results or leaks or even if therapy is optimal.
All they want to know is that you are using the machine the minimal required number of hours.

And just in case you are told the big lie "it's against the law for the patient to change anything"....ask them to prove it in writing and show the documentation and the law. There is no such law. Patients can do whatever they want.
Now the DME...they can't change anything without a doctor's okay but the patient isn't under the same restrictions.

Someone gave you the Medicare requirements....if you don't have Medicare call up your insurance company and ask them what their requirements are.
Don't ever accept what the DME tells you without verifying it yourself with your insurance company.

[rdfry]

Why would Apria, who isn't an insurance company be telling you anything? Did your insurance company stop paying them? As long as they get paid it is none of their business.

[chunkyfrog]

Only the insurance company can tell you about your coverage conditions.
DMEs are only motivated to MAKE MONEY.
They have no scruples.
Insurance companies aren't much better--but if they get caught, it could get ugly.

[ChicagoGranny]

Why would Apria, who isn't an insurance company be telling you anything?

They CAN tell a patient he has to show that he is meeting the insurance requirements for usage or they will charge him the full price of the machine.

DMEs have been burned many times by patients who don't meet the usage requirements and don't want to pay when their insurance refuses to pay.

Certainly, DMEs have a long history of lying to patients. However, they provide an important service in submitting documentation to insurance companies and collecting payment from insurance companies on behalf of patients.

Buy your own machine and then try submitting sleep study results, a prescription and documentation of usage to your insurance company. Then wait for up to six months to be reimbursed. Repeat this process multiple times. Would you want to do that? That's what DMEs do.

[ChicagoGranny]

They want me to use the my air app. ... Keeps showing no data.

If you are looking for data first thing in the morning, it won't be there. The data is transmitted later in the day.

If you see no data for earlier days, there might be a problem. Do you have Airplane mode turned on? Do you have cell service in your bedroom?

[ChicagoGranny]

I took my modem right out and Apria tried to get me to pay them more than the insurance price but in court I proved I was using it more than 8hrs/day with my OSCAR reports and notes from my doc.

Sounds silly if true. This is the kind of grump that clogs up the courts with things they could have easily been handled without lawyers and judges burning taxpayer money.

[Janknitz]

For some reason the DME's worry about us changing our settings not the insurance or even the doc prob doesn't. The DME also worries about hours of use so they can get paid. So you can disconnect the modem to see if the DME is watching but as long as the hours are on the machine you can prove it.

I took my modem right out and Apria tried to get me to pay them more than the insurance price but in court I proved I was using it more than 8hrs/day with my OSCAR reports and notes from my doc. Apria never contacted me to get any data.

The modems used to be a separate item that plugged into your CPAP machine, but now they are integral to the latest models. So there's no way to "take it right out". But you can put it in airplane mode so that it will not send the information to your DME.

However, during the compliance period, you probably do not want to do that, because then you either have to turn over your SD card to them so that they can read the compliance data to report it to your insurer, OR they are going to want you to bring your machine in to them for the same, so that they can document compliance and get paid. DME's kind of like getting paid, and if the insurer refuses because compliance can't be documented, you can bet the DME will expect YOU to pay.

Once your compliance period is over, it's none of their business. My machine has been in airplane mode since the day it was paid for (in my case, there was no compliance period, so it was the day I got it).

I can't imagine ANYBODY going to court over this--ridiculous! The time and expense and stress are hardly worth the effort--it would have been easy enough to transfer the data to an SD card for Crapria to read--that's how they did it before modems were common.

Note that if you change the settings and the DME happens to notice while documenting the settings, it's possible (though unlikely) they could change them back. If you feel like your therapy is "different", check your settings to make sure they are as you set them.

[SleepGeek]

The modems used to be a separate item that plugged into your CPAP machine, but now they are integral to the latest models. So there's no way to "take it right out". But you can put it in airplane mode so that it will not send the information to your DME.

Check this video, in <5sec its in airplane mode, no buttons to push, no screws to remove, no problem. I saved mine in case I needed it again. https://www.youtube.com/watch?v=yRbOdiHykRA

However, during the compliance period, you probably do not want to do that, because then you either have to turn over your SD card to them so that they can read the compliance data to report it to your insurer, OR they are going to want you to bring your machine in to them for the same, so that they can document compliance and get paid. DME's kind of like getting paid, and if the insurer refuses because compliance can't be documented, you can bet the DME will expect YOU to pay.

Since Apria never notified me of the modem and I did not sign any release I felt free to remove the modem.

For whatever reason Apria never contacted me or even attempted to contact me to get any data or even to see if I was having a problem using it. You're right for my 1st cpap back in the old world they would send someone out to the house to write down the hours and AHI from the screen. They never took a data card for any reason - all they are interested in is Hours of Use.

So I think their plan all along was to wait the compliance period (13 months) and they thought they could get more than Medicare would pay them for the same device.

Once your compliance period is over, it's none of their business. My machine has been in airplane mode since the day it was paid for (in my case, there was no compliance period, so it was the day I got it).

I can't imagine ANYBODY going to court over this--ridiculous! The time and expense and stress are hardly worth the effort--it would have been easy enough to transfer the data to an SD card for Crapria to read--that's how they did it before modems were common.

Note that if you change the settings and the DME happens to notice while documenting the settings, it's possible (though unlikely) they could change them back. If you feel like your therapy is "different", check your settings to make sure they are as you set them.

Are you defending Apria? It was Apria who took the legal road on this - not I. You can pay them $2200 for a bipap I was not about to.

I contacted the State Health Insurance Assistance Program who helped resolve this saying they have heard of Apria pulling this before.

I don't know anywhere in the Medicare guidelines/rules that says you have to have a modem or that they will pay for a modem. I had all the documentation to prove I used it for 100% of the days in question, not one missed day - the doc had all the data and was paid w/o problem.

When all was said and done I received a document transferring ownership to me. They then had to bill Medicare for the next 13 months - so they got their money just not as much as they wanted or as soon.

When dealing with DME's I give them my insurance and co-pay insurance - never ever a credit card for any reason - and as I recall they did ask but I told them if the code it right and Medicare pays then TFL will pay automatically.

[chunkyfrog]

On the very remote chance that somebody thinks you have monkeyed
with your machine, just blame it on curious grandchildren.
Always have a believable excuse.
You will probably never, ever use it--but you need not worry.

[Janknitz]

So I think their plan all along was to wait the compliance period (13 months) and they thought they could get more than Medicare would pay them for the same device.

You are confusing the compliance period with the capped rental period. The compliance period for Medicare is 90 days--you must use your CPAP at least 4 hours per night for 70% of nights (that’s 21 nights) during a consecutive 30 day period any time in the first three months of initial usage.

The capped rental period is 13 months.