That is a great question. Here at the sleep apnea girl testing center, we try to let people know what will be expected from your health insurance to purchase or rent a CPAP machine for you. For most insurance companies today, your initial prescription for your CPAP should cover at least 3 months. Unless your MD writes a length of time or lifetime. During this time your health insurance wants to confirm that you have adjusted to using your CPAP machine on a regular nightly basis. If there is no evidence of using referred to as COMPLIANCE, your insurance company will not reimburse for your CPAP device beyond the first three months. This is why you really need to be honest with yourself. Will I have trouble using my machine every night? Do I travel a lot for work. Do you move around a lot? If you feel that your lifestyle will make it difficult for you to meet this requirement of COMPLIANCE. I would suggest purchasing your machine where you feel comfortable and will get the most support and coaching. If you wish to keep your CPAP machine beyond the 3-month period, you will be financially responsible for paying for it. We have people getting upset that the company is picking up the machine. You need to understand they are not getting paid for the machine from your health plan. They should not be responsible for your payments. Also, if you do not have Wi-Fi on your CPAP machine you will need to mail in your data card to the DME (Durable MEDICAL Equipment) company that is helping you with the CPAP DEVICE. Insurance Definition of Compliance. The patient must demonstrate that they are using their CPAP DEVICE a minimum of 4 hours per night on 21 out of 30 consecutive nights during the first 90-day period. Some insurance companies want compliance for an entire year! Unfortunately, do they care if you stopped breathing for 100 times for 10 seconds or longer no... They want you to follow these compliance guidelines, how do they know if I am using my machine? DATA CARD or computer compliance and monitoring.
The old way is a DATA card. Your CPAP machine could have a memory card inside known as a DATA card. Your DME company could ask you to mail that into them. 1. The Data card will be downloaded, and a report will be generated that proves to your insurance company you are using your machine. If you meet the insurance company compliance criteria this will be sent to your insurance company with future claims to pay the company for your machine.
2. Air view, Care Orchestrator and so on. Most manufacturers who provide CPAP machines have applications that can be generated by your DME company downloading a compliance report. This makes your and their life so much easier. They will generate a report of your 90-day CPAP usage and send this to your insurance company. Usually, the medical equipment company will tell you if you meet your compliance guidelines otherwise, they will be calling with the bad news that they need to pick up your CPAP machine. Believe me they do not want to. If this is too much monitoring for your personality, I say buy your machine. They are not that costly and worth their weight in gold to get a healthier, beter night’s sleep. Knowledge is power. Start understanding what it is that is required of your health insurance.
Sweet Dreams and healthy sleep loves you!