Compliance & BiPAP Pressure Adjusting

[kbear]

Newbie Question:

Does insurance compliance only require PAP machine usage time (ex. BCBS of AL requires 70% of days at >4Hrs for 10 months) or do they require PAP usage that is based on the "time using doctor's prescription"?

The reason why I am questioning this is that after 2 months of dealing with the side effects of my high pressure prescription, I finally saw my sleep doctor for the first time since my sleep studies. He reduced my pressures in half. However, I think that my settings can be tweaked to bring my AHI down more, but I'm afraid that deviating from my prescription will throw me out of compliance. And I can't afford to pay back the money that my insurance company covered for my $5000 BiPAP.   

Thanks.

[dmeRT]

Insurances don't verify prescription settings, they only look at the time your using therapy. You have to prove compliance in the first 90 days. doesn't matter if dr. changed your settings 2/3 of the way through you only have 1 month left to prove compliance. If you had changed to a different machine, say advanced to bipap from cpap, then you would get 90 more days to prove compliance with bipap.

Hope that answers your question....

[BTS1]

$5000 BiPAP, something up there ... Hell I am on ASV and just got the new Aircurve and it was not even close to that ... Also there isn't a 10 month compliance.. it is whatever machine you are on, using it for 70% of the time for 30 days at a min of 4 hours a night, you have 90 days to complete this ..

[kbear]

Yes. Thank you for your response.

[kbear]

$5000 BiPAP, something up there ... Hell I am on ASV and just got the new Aircurve and it was not even close to that ... Also there isn't a 10 month compliance.. it is whatever machine you are on, using it for 70% of the time for 30 days at a min of 4 hours a night, you have 90 days to complete this ..

I misunderstood about the 10 months. That’s the wait period before insurance will pay for pap related supplies. DME’s make a big profit. I saw my same machine online for as cheap as $3999 not including modem, tubing and mask. Thanks for your help.