Why does insurance care about compliance?

Do insurance companies care about compliance for its medical benefit or simply to justify continuing coverage for CPAP equipment and supplies?

I was diagnosed with mild OSA about six months ago. I have a high cost-low benefits health insurance plan, so I bought a used machine from a private individual. Since no DME was involved and since I did not file an insurance claim, I am now wondering whether my insurance company might conclude that I have left my condition untreated. Does it care? Should I do something?

I think they only monitor compliance to avoid paying for a machine you're not using enough. Or as a reason to deny benefits. You might have problems if you wanted them to pay for followup doctor visits, supplies, etc.

I suppose a "smart" insurance company might want to monitor compliance in order to avoid the health effects of untreated apnea, but I doubt that will happen very often.

IMHO most insurers are run by bean counters, not humans, and short-sighted bean counters at that. That's supposed to be the difference with HMO's and SOME actually do. Kaiser sees the value in treatment, not just compliance. They have a pretty aggressive program to identify people who may have OSA and to test and treat them. They have a patient Ed program and follow-up for efficacy, not just compliance.

I hate to sound like the Kaiser cheerleader, because I'm really not, but I do think they do a good job with SA--at least in my region. They recognize that treating OSA well saves them money downstream.

I don't think insurance company want to try to police compliance. If they started doing that then they would need to start making sure we took prescriptions and if doc says come back in 3 months make sure we did. Too much work involved.
I use insurance for mask and supplies. Never claimed a machine because I bought privately. Insurance has never questioned things. Been nearly 2 years now.

Six years ago, I bypassed the local DME establishments.......purchased all of my equipment from CPAP dot COM and submitted an invoice to my insurance.......which they reimbursed me for 80% of my purchase. I got the impression talking to them that since I had purchased everything out-of-pocket, that they felt that I was going to be "serious" about my therapy.

Beyond that, neither my insurance or medical professionals have ever asked me to verify my compliance with my therapy. However, I have been very diligent in downloading my detailed data and saving my reports........just in case it might ever become a legal issue (like an automobile accident).

I see in your profile that you have the software. I would recommend something similar. It never hurts to CYA.


Den