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Author:  MaskedSleeper [ Sun Aug 16, 2015 5:02 pm ]
Post subject:  Compliance

Since my pressure requirements are high, I feel it would be beneficial to use the auto bi-level feature of my machine and set a pressure window range between my 2009 sleep study (20/12) and my 2015 study (23/15). I will discuss this with my pulmonary/sleep doctor at my appointment next month. My primary concern at the moment is with compliance.

In addition to seeing my doctor and proving adherence to therapy defined as use of PAP ≥ 4 hours per night on 70% of nights during a consecutive thirty (30) day period anytime during the first three (3) months of initial usage, does compliance also include non-modification of PAP device parameters prescribed by my treating physician? If I alter settings from his prescription will I remain in compliance or would I increase the possibility of denial of payment?


Author:  kaiasgram [ Mon Aug 17, 2015 1:08 am ]
Post subject:  Re: Compliance

Compliance is for the insurance company. All the insurance company cares about is whether you've met the hours requirements for them to pay for the machine. They don't care what your pressure settings are/were. It's not unusual that the pressure(s) at the start of therapy get changed in the early months -- if not by the doctor, by the patient. Insurance coverage is not contingent on the pressure settings, only on the hours of use.

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