Worried about insurance requirement to see doctor within 90 days

[NewlyDiagnosed]

I was diagnosed in February by an online sleep test from Lofta, and a doctor 3000 miles away signed the prescription.  I called the local sleep medicine clinic in mid-February to make an appointment, but the first available was in mid-December.  I am on a list for cancellations.

I picked up my equipment last Saturday, nothing but problems so far, have ordered 2 new masks today.  I learned that the insurance company requires that I see my doctor within the 90-day compliance period.  I don't want to say that I can't see the doctor, have never seen the doctor, it's all online, because they might invalidate the insurance coverage (which is quite good, so I don't want to lose it).  I will call the sleep clinic periodically to try to get in, but if I can't, does anyone know if Lofta will arrange whatever documentation I need from this doctor?  I'd be happy to pay the fee, of course.

Maybe I could call the doctor's clinic and ask for a tele-appointment?  I wonder whether that would satisfy the insurance company.

[Nightynite]

You can just go to your regular PCP. You don’t need to go to a sleep clinic.
You can take a report from Oscar or MyAir app. Just show the Dr. your using it and have them document it in your medical visit. Tell them this is my compliance visit for my cpap therapy and they will probably know what to do anyway.

[Nightynite]

If you were to download the MyAir app today, you could start recording compliance history tonight.
You just need the serial number from back of machine and a unit number also on back of machine. Enter that in the app set up menu. If you have a card to cloud machine you will need to use the Oscar free download and put a sd card in your machine.

[Rich66]

You might try some of your local Pulmonology doctors. My local one has a sleep clinic they work with, or own it. Maybe they could get you in a proper sleep study. I don't put much value in a 'home' sleep study (I've had two), let alone an 'online' one. They are right about the 90 day followup -- the doctors want to see that you're using the machine for a minimum of 4 hours at 70% of the time. And maybe your machine will 'send' the data to the other 'doctor'.
Sadly, it seems a lot of this Sleep issue is a money grab without telling the patient a lot they should know -- thus, this site is so popular. My first Pap machine I was given to use was so outdated the DME (such as Lofta) didn't have the equipment anymore to monitor me. But they got paid for getting that brick out of their old inventory. Their money came before my health -- and I really disagree with that.

[NewlyDiagnosed]

Thank you so much, NightyNight. That's a relief.

Rich66, my preference would have been to see a local doctor, but there didn't seem to be that possibility in less than 10 months. I will take your suggestion and try pulmonologists rather than sleep clinics. It might be faster to get in that way. Thank you.

[Sleeprider]

My primary care doctor has done all my follow-up and renewal prescriptions. My last sleep study was in 2008 and I never personally met with the sleep doctor. For most insurance the sleep specialist is only required to sign off on the sleep study. Your "treating physician" can be your PCP, and all he has to do is determine you are using the therapy and benefiting from it. This is not a very high mark to hit.

[UnicornRider]

I agree with Sleeprider, Just take a copy of your summary page to show compliance.

Now I have to be up front and tell you as a Severely Compliance Challenged Individual, my sleep Doctor taught me a slick trick.

 The bottom of the Statistics page of OSCAR you can select Standard, Monthly or Date range. Use it to your advantage.

 (Figures don't lie, but Liars can figure)   

[NewlyDiagnosed]

Thanks for the tip! I hope I will do so well when I get the mask sorted out that I won't need selective reporting, but good to know about the possibility just in case.

[UnicornRider]

You will do well, I am a "Special Case".  After Chemo and Radiation therapy, my skin would breakdown with the touch of the mask. There were days when I wanted to wear the mask but had no good surface left. That is how I ended up with the FitLife Total FFM & silicone ear plugs rolled into gummy worms for caulking the leaks. I do not recommend that FitLife Total FFM at my therapy pressure. But it is a very good mask! And it afforded me time for my face and nares to heal so I could start rotating thru Nasal, Pillows, Wisp,Hybrid, FFM and then the Total FFM again.

   I guess I should have shared my Statistics page at the end of March so everybody could celebrate with me, it was my first calendar month with 100% compliance in several years. April has already been screwed over, so now I start hoping for another shot at getting a full month with 100% compliance, perhaps May.

   I am really blessed to have found a very good Sleep Center, Oncology Team, PCP and the Dermatologist, He keeps finding scars on my face that look "suspicious" for possible cancer, so he takes a biopsy, throws a couple of stitches in there and two weeks later when he removes the stitches you could not even tell there was ever a scar there. He is a fantastic Plastic Surgeon, with a full service Beauty Spa.

  Now if I could get him to Liposuction about 30 pounds of suspicious fat.  


Hang in there you will have an easy time with the help of the good people here.

[UnicornRider]

BTW, that Evora is a very good mask, it likes to float on the skirts like a Hovercraft. Most people, myself included, have over tightened it. give it a chance.