New Member with Questions

[TalonPI177]

Hi everyone. I'm brand new to the Apnea Board and I'm in need of some advice and answers. I've been a CPAP user for about a decade and I currently use a PR DreamStation BiPAP. Unfortunately, after 3 years of use, the unit died last night. I called the DME that supplied the unit at the direction of my sleep doctor.
I was told that I had to get another prescription from a doctor or insurance would not pay for a new one.

Can you folks help me get answers to the following questions?:

1. The first thing the DME rep said was "I don't have any compliance data on you." Why would you, I asked. No answer. I told her that the machine doesn't have a modem anymore since I took it off because I don't feel the need to share data on my sleep habits with anyone except who I choose and it's never been a problem before when they call me up about supplies. They always ask questions about how many days and hours I use the machine and I answer. This has always been sufficient for them to send me supplies and the insurance has always paid for it.
A.  The first question is: Is it normal that a DME would set up the CPAP machine to send the compliance data to them?
B. If yes, how is that not a HIPPA violation? They're are not my doctor.
C. If no, who is that cellular modem calling and who is getting that data?

2. The prescription:
A. Isn't the prescription good for life or until I choose to get another sleep study or have a discussion with my doctor to have the prescription changed?
B. If the prescription doesn't expire, why would the DME require a new prescription because the machine broke?

[Plmnb]

Welcome from a fellow newbie!  I'm sure you will get your answers here.  I was curious about your questions and did a Google search on the HIPA biz.  I found this.  I don't know if it applies to you or not for sure, but it is interesting.

[/url]482-Does HIPAA permit a health care provider to share ...


https://www.hhs.gov › hipaa › for-professionals › faq › does-hipaa-permit-...

1. [url=https://webcache.googleusercontent.com/search?q=cache:Zn9IpsC1pVEJ:https://www.hhs.gov/hipaa/for-professionals/faq/482/does-hipaa-permit-a-doctor-to-share-patient-information-for-treatment-over-the-phone/index.html+&cd=10&hl=en&ct=clnk&gl=us]
   

Nov 3, 2003 - Answer: Yes. The Privacy Rule allows covered health care providers to share protected health information for treatment purposes without patient authorization, as long as they use reasonable safeguards when doing so. ... A laboratory may fax, or communicate over the phone, a patient's medical test results to a physician.

Someone else I'm sure will correct me if this does not apply.

Good Luck!

Plmnb

[harrywr2]

Current generation Resmed machines send data to Resmed. Then whoever has been provided with the serial number and pin number on the back of the machine can access your data.

Medicare and most insurers require compliance data from the machine. In the case of Medicare the DME tracks compliance.
I have Kaiser Permanente insurance and they track compliance themselves, if I want Kaiser to pay for my supplies the Kaiser Sleep clinic has to certify my compliance annually even though I have a lifetime prescription. They do this by accessing the Resmed data using the Serial number and Pin from the back of the machine.

I'm pretty sure when I picked up my 1st machine from the DME I signed a HIPPA form giving permission to access my data for compliance purposes. (I gave back my 1st machine after a billing dispute with the DME).

[Dormeo]

I suspect that a lot here depends on the terms of your insurance. I would suggest focusing on getting a new prescription from your doctor, partly not to get bogged down with the DME and partly because you have an opportunity to ask your doctor for the machine you want. Be sure to get your own copy of the prescription.

And after reading many posts on this site, I would suggest that you ask for a ResMed AirCurve 10 VAuto. Many people find that it is a more comfortable and effective machine. Of course, if you like the PR machine and it gives you good therapeutic results, you can stick with it. Nothing wrong with that.

[17WRX]

I also recommend the ResMed AirCurve 10 VAuto. I have one and its very comfortable compared to other cpaps I've used.

Welcome to the forum.