Insurance compliance question

[vsheline]

When i picked up my equipment i had a form i had to sign and it stated that "if by the end of two months, you have used the CPAP at least 70% (equating to 4 hours per night), your insurance will reauthorize the unit for the additional rental period".

This means you will be in compliance if you have used the machine for at least 4 hrs per night (I think all time is counted while machine is delivering pressure, including time when awake), for any 42 nights during the 60 day period. (42 days is 70% of 60 days.)

I think some insurance companies may require 4 hrs and 45 minutes miminum use during a night, for the night to count.

[Bernie]

Thank you archangle. What you wrote was very helpful. I appreciate every word.

This has been a very informative thread. My sleep doctor prescribed a fixed pressure, but upon my insistence, he did specify the S9 autoset. My provider first supplied a Resmed CPAP unit but I refused it and insisted on the S9 autoset. They ordered the S9 autoset after I wrote them a $250 check for the price difference. They said that they had reported the unit to Medicare as a CPAP, to keep the Medicare records straight.

Anyway, I've used the S9 autoset for over a month now but they have not asked for the SD data card and they have not contacted me about getting compliance data.

Does anyone have current information on the Medicare requirements for compliance and for granting me final ownership?

[archangle]

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This has been a very informative thread. My sleep doctor prescribed a fixed pressure, but upon my insistence, he did specify the S9 autoset. My provider first supplied a Resmed CPAP unit but I refused it and insisted on the S9 autoset. They ordered the S9 autoset after I wrote them a $250 check for the price difference. They said that they had reported the unit to Medicare as a CPAP, to keep the Medicare records straight.

Anyway, I've used the S9 autoset for over a month now but they have not asked for the SD data card and they have not contacted me about getting compliance data.

Billing you extra for the AutoSet probably violates their contract with Medicare and is probably a federal crime, especially if they billed Medicare for the machine. Usually, APAPs and CPAPs are billed under the same code for insurance, and the DME is required to accept a fixed fee for the machine, no matter which CPAP it is.

It was probably illegal to try to dispense anything other than the AutoSet if the doctor wrote "Dispense as written."

However, they could probably have refused to dispense an AutoSet, unless the prescription specified a pressure range.

Your call as to whether you made an honest deal with them and whether to pursue the issue.