compliance question

[singergal67]

I've been on CPAP for about 2 and a half months and am finally able to get more compliant nights. However, with my understanding of general compliance rules, even if I am compliant every night for the next two weeks I will not achieve the compliance I need for this 90 day period. Will my bank account get drained if the insurance balks at paying? Is there a grace period?

[Gideon]

Talk to your doctor. Tell him that, and that you FINALLY are compliant but will not meet full compliant requirements on xxx. Date, but you are now Good but just n|d more time

The bottom line is they want you to use it. But if you are not they don't want to pay. You should be ok.

[martyedb]

May I add a comment regarding this word "compliance"?

[staceyburke]

I have been on Cpap for about 30 years but when I started I had a problem with having enough hours a day for insurance. I “solved” my problem by watching TV and reading a book before I went to sleep wearing my Cpap before I went to sleep. The machine does NOT k now if you are asleep or not but only that you use it 4 hours a night.

[martyedb]

NON-COMPLIANCE is "failure or refusal to comply with something, such as a rule or regulation". So it sounds as if CPAP users who are having difficulty with their therapy are being blamed for not following directions . I think this expression is harsh, like being punished.
I think that many of us needed more support when we started, more than one hour of instructions. A scheduled follow-up appointment after a week or two could be helpful. Anxiety levels can make it more difficult to follow directions.
The staff at the DME may make certain assumptions. For example, they may assume that a full face mask will be required for all "mouth-breathers".
A short written introduction to CPAP therapy could be helpful for some of us.
Maybe our sleep doctor increases the pressures when AHI is still high, and that contributes to more leaks.
Maybe there are many leaks because you have the wrong mask, so you awaken many times each night.
Sooner or later, you may find Apnea Board, and then things can improve faster.
(THANK YOU, APNEA BOARD!)

[OpalRose]

I agree with much of what you are saying, but Medicare and many insurance companies have set the standards to be followed. If that standard isn't met, they can take your Cpap.

Although it is up to the patient to keep in contact with their DME and doctor during that compliance period, especially with mask issues. Be a squeaky wheel so to speak.

I'm sure that most here are familiar with this, but for those that aren't:

Compliance:
Medicare requires that a patient use CPAP for more than 4 hours per night on 70% of nights (21 nights) during a 30-day consecutive period any time in the first three months of use.
Patient must also have a face to face appointment with their doctor any time after the first 30 days, but before the 90 days expires.

[David Clark]

Insurance has never been involved in my therapy. Not from the "at home" sleep study, to purchasing my pap machine, mask and supplies. Yeah...it's a little more costly since I'm paying for everything myself but on the bright side, I'm the only one I have to be "compliant" to.

[singergal67]

I'll definitely talk to my doctor about this. It's only after I discovered this site and how to adjust my settings that I became able to use it more. It didn't help that I had a bad cold for a week too and couldn't use it so if the doctor puts that in my chart maybe that will help the cause. I agree the word compliant has negative connotations when the reason we're not always using it is because of problems with therapy. Of course insurance companies make lots of money by denying payments.