Cigna Insurance, Compliance

[Crippiter]

Sorry if this is a repeat (I might've posted on the old board), but I'm just comfortable about whether I have the information I need here. The subject: Compliance

My DME clinician never mentioned compliance when I was setup with my Resmed S9 Autoset. When I had a two-week follow-up with her, she mentioned in passing, "Y'know, that's all insurance cares about is compliance, not whether or not the equipment is working to remedy anything."

This was in response to my first two weeks' data, with several evenings only getting by about 1-2 hours before I'd yank the thing off on my sleep because of the "smother" effect. Still, she never really explained what she meant.

I've read here and other places about compliance, and that insurance may only cover if the patient is using the device 4 hours per evening over 70% of the evenings... or something like that.

I'm planning to travel with my wife overseas, and I'm not sure I'll have room for this thing. We're questioning whether to take it with, and compliance is my concern. So I called my insurance provider, Cigna. The woman seemed completely unaware about compliance. I mentioned what I thought it meant, and she just said, "We don't know how much you wear it, we don't get a signal when you wear it..." (Does she think I'm expecting that Cigna is wired in to my CPAP?) Anyway, the message I'm hearing from her is compliance is a non-issue.

I stressed with her that I don't want to be surprised by this. I don't want to find out later that I'm getting billed because insurance thinks I don't need the unit because I'm not using it.

SO... anyone who's on Cigna in here... have you hear similar messages from your insurance provider?

Thanks!

Crippiter

---

(I might add... this customer service agent suggested that docs need a prescription to change the pressure setpoint on a CPAP... !?!?)

[PaulaO2]

I am not a user of Cigna insurance.

BUT, you would be better off taking it with you. You can leave the humidifier half at home, if space is a major consideration. You want to be able to enjoy this vacation and lousy sleep is not taking you anywhere near that.

As to Cigna, contact your sleep doc's office and ask for whoever deals with the insurance companies. Ask him/her for their opinion.

[zonk]

Hi Crippiter
Never mind about the insurance compliance requirement, I wouldn't travel anywhere without my S9 it,s a life saver plus it,s a carry item and medical equipment don't count as luggage on airlines.
Bon voyage (with CPAP)

[greatunclebill]

you obviously don't know it yet, but cpap is life saving equipment, not an optional thing or a feel good thing. I pray you or others don't learn that the hard way some day through an unexpected trip to the ER.....or worse.

[Crippiter]

I appreciate the feedback, and I will contact my DME and doc office tomorrow.

Just to clarify, my experience with my Resmed isn't as life changing as yours (at least not yet). In my case, my AHI and pressures are still quite high (so the benefits aren't so notable), I'm struggling with pretty annoying bridge-of-my-nose irritation with my Mirage facemask (even with the screw extended), and I'm still waking up to the smother effect often at night, so it's not exactly making my nights enjoyable. No, I'm not quite in the "Resmed is a life saver" camp, at least not yet. I'm not quitting on it by *any* means, and I'm still hopeful, but I can go without it for a short while and not feel like my life is worse off.

[Steven]

I have a BCBS PPO plan.

Their idea of compliance is to have the DME provider call me & ask if I am using the machine. No one ever looks at my machine or SD card to verify that I am using it.

For the 3 machines I have had in the 13+ years on CPAP, my insurance has never required that "rent to own" thingy either. So, if I had ever not been compliant, what would they have done? Take my machine away?

Having said all of that though, "I" believe that all insurances do require compliance. The Question is how will they verify that compliance.

If they do require you to submit either your SD card or your machine for verification, you may have a problem since you are in fact not compliant.

Then, the next Question is what will the consequences be of your non compliance?

[Crippiter]

Just saw Great Uncle Bill's reply, which included a more pointed comment about me choosing not to use the equipment.

Again, let me state... I'm not being flippant about my CPAP use. I *want* this to work, and even with the nuissance issues I noted above, I'm still wearing this nightly at home. I go to work every morning with an odd-looking sore on my nose, with people staring at scar-face, knowing it's the right thing to do. But I also haven't seen evidence that my Resmed itself is *dramatically* changing my AHI, any more so than simply ensuring I sleep on my side and not my back (if I'm on my back, the unit's useless anyway). I still go through bouts at night (most likely when I'm on my back) where I have dozens of events per hour. I also have 20-30% centrals on some night that aren't even touched by the S9 (and knowing this, my doc expressed no interest in changing my course to alternate PAP systems).

So it's not that I want to play games with my life or risk dying for the sake of reduced luggage. I'm just weighing benefits and drawbacks, and I simply don't have as much benefit from my unit as some do. And I'll stress again, *not yet*, because I *am* sticking with this to eventually find a system and other tools to improve my sleep.

Sincerely, I appreciate the feedback, and I take it to heart. I wouldn't have asked the question if I didn't want to hear your thoughts.

By the way, Uncle Bill, I enjoyed your signature about your dueling systems with your wife.

---

Steven, I am generally in compliance over the long haul... I wear this thing nightly and have been able (finally) to keep it on for 4-6 hours per night. So mostly I'm doing well. But it's a question of specific events like this.

I was thinking the same thing about SD cards, and verification... and also whether or not Cigna seeks verification, would my doc or the DME do so? They're the ones looking at the more regularly (so far only once) for diagnostics and such. Might they report to insurance that I'm not using it? I don't know.

And to your point, I already payed a chunk for this... so maybe my point is moot? Hmmm...

[greatunclebill]

i don't know what you have had access to so i may be out of line, but because you're seeing high numbers don't mean that your machine is not doing good. your numbers without using the machine (pre-treatment) may be off the top of the scale high. i think you may need a different sleep doc if you're seeing a sleep doc. if you're not seeing a real sleep doc you need to find one. my comments were because i spent a night in the ER directly related to not using my machine. I'm frankly scared to go to sleep without it. to me it is life saving equipment.

if your numbers are bad we have some wizards here that are very good at advising how to get them in line. it might be best to start a new thread with questions.

if you're not feeling better yet, that is to be expected. sometimes it takes time. it doesn't mean tratment isn't working.

if you have high numbers, you are on the machine til death do you part. in the real world (don't take that the wrong way) there is no other viable solution short of tracheotomy (sorry ltmedic). if there were viable alternatives doctors wouldn't have us wasting time fighting with masks and insurance companies wouldn't be paying for cpap's.

take the equipment with you.

we post because we care. we all certainly have better things to do with our time.

[tombarelybreathing]

Hi Crippiter,

I know exactly how you are feeling. I went throught he whole sore nose thing ( on the bridge where the mask sits) and I think most of us here did
I can tell you from my experiance that I thought I wouldn't like nasal pillows so I put up with the face mask rubbing my nose raw. My DME finaly convinced me to try nasal pillows and I can honestly say that it was the best thing I've done!!!!

I now sleep really good ( still some bad nights though) and my nose is never sore anymore. It takes time and lots of trial & error before you get it set up for your way of sleeping and your comfort level. It's definately not easy to sleep with a cpap but it sure makes a difference in energy levels and quality of life...I am a believer that cpap is the best treatment and I use mine every night!

tombarelybreathing

[PaulaO2]

I went through I guess six or more nasal masks before they talked me into trying nasal pillows. Instant love. I have an odd nose and we could not find one that fit well enough to stop the leaking at the eyes. Then there were the pressure spots. Then the eye irritation. And the reaction to the silicone. I heart nasal pillows!