Hi luminous,
It's curious to note that you are a member since 2014, so I apologize if this post rehashes stuff you already know. Also wondering if maybe this is a replacement machine you are going after? That might make a difference in the compliance requirement, which you may have already met long ago with your old machine? Or are you just talking about reordering supplies and getting snagged in all this compliance BS because of the new DME? I'm confused about what you are asking about.
[UPDATED] Since you mention that your old DME who accepts your new insurance says they can supply your equipment, then I would go get a copy of whatever they have in their files which establishes your compliance and allows them to sell you stuff, plus get a copy of the original CPAP prescription they used to order the machine you have now. That stuff will be golden and may answer the entire question for you. Get copies and keep a copy in a safe place. Then you will have it handy if you ever change DMEs again. Maybe that's all you are asking about, and if so then hopefully it's that easy to resolve for future reference.
I think all the discussion above, and my original response below are all based on the idea that you are trying to establish compliance, not that you already had established compliance with the original DME. So at least for my part I may have originally missed the mark, but since I spent a lot of time composing it, here goes:
I would call your current insurance company to clarify the situation and ask them IF and WHAT they require for compliance. The DME is a vendor who provides you with equipment and bills the insurance company. The DME requires compliance data only if the insurance company requires it of them, but they might be working on the assumption that compliance data is always required.
DMEs are not like doctors and other medical providers in the sense that your doctor chooses which insurance companies they will accept. But in the case of DMEs, it is your insurance company who accepts the DME. DMEs compete and bid aggressively to win contracts from insurance companies to be their providers. So the dynamic is a little different. You might think it doesn't make any practical difference but the decision maker for medical equipment is your insurance company and not your DME. So when you need to get clear about policy, talk to insurance not the DME.
It is common for insurance companies to follow Medicare guidelines (see link below), which require the stuff the others mentioned above. I believe one fine point about the Medicare requirements might be that it's the doctor who reviews the compliance data and makes a determination / recommendation that the therapy is effective and beneficial for you. That is documented in the face-to-face followup meeting. This closes the loop on the requirements. And this may be why the DME was confused about demonstrating compliance to them. Check me on that one, but I suspect the doctor followup visit is the key to establishing the compliance.
Note that it is also common for private insurance companies to NOT require compliance data and simply buy the equipment outright. That's what my insurance company did. The doc said we needed a CPAP machine, and the doctor's order was good enough for my insurance company. We had the option of whether we desired to rent-to-own or purchase outright. Our DME (who had already prepared a rent-to-own contract which we rejected) was surprised to hear this, but they called the insurance company and verified what I had told them. We left the DME store that day with a machine that was purchased outright and with no requirement to demonstrate compliance. Insurance varies, and not everyone will be as lucky as I was.
While you have the insurance company on the phone, ask them about lease versus purchase. The benefits of your policy will be clear and you may have the option like I did to choose how you want to proceed.
Always, always, always, talk directly to your insurance company. Use your conversation with the DME to confirm what you already know from the insurance company, and if there is ever a conflict then go back to insurance to clarify.
The insurance company calls the shots, and in my experience the insurance company customer service is always happy to explain the benefits to you. Then you are in a position to make decisions and tell the DME what you require from them.
Remember you are the customer and the DME is a vendor who wants your business. You need to be an informed customer. Your constraints are dictated by your insurance company not your DME, so don't get confused and let the DME tell you what their policy is. Yours trumps theirs if they want your business.
People with our condition already feel lousy enough fighting through the fog to deal with all this stuff. Hope this whole discussion thread is useful info that will help you sort through the crap, get your machine, and start feeling better soon.
Saldus Miegas
p.s. here's a link to the medicare policy on CPAP machines which says in a lot more words what the others have said above. I grabbed it from a google search and I think it is actually a health provider quoting the Medicare Policy, but it seems to agree with everything else I have seen written elsewhere about it. For some reason I can't find the authoritative Medicare web page tonight.
http://www.genesishealth.com/care-treatm...-for-cpap/
Medicare Guidelines for CPAP
1) The patient must have a face to face evaluation with a physician of their choice. At this appointment there must be documentation of symptoms of OSA, a completed Epworth Sleepness Scale, BMI (Body Mass Index), neck circumference, and a focused cardiopulmonary and upper airway system evaluation. This appointment with the physician must always proceed the baseline sleep study.
2) If the patient is currently using CPAP and becomes a medicare patient, the first baseline must meet Medicare criteria. It does not matter how long ago this baseline was performed. If the patient did not have enough OSA then the patient must repeat #1 and re-qualify for CPAP. If the prior baseline met Medicare criteria, the first face to face with the physician, after going on Medicare, must include documentation about the patients compliance of CPAP according to Medicare guidelines.
3) After 3 months, if a patient did not prove nightly usage of CPAP, Medicare will not cover the cost. If the patient wants Medicare to cover the CPAP again they must start with a new face to face evaluation prior to the CPAP.
Medicare Coverage of CPAP at Home
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.
