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Compliance Check by CPAP Provider
My durable medical equipment company called the other day to check up and see whether i was using a newly prescribed machine. I kind of fudged the truth and said that i'm using it without any problems, which i'm not. My question is if they check the data card on my machine can i get into trouble or have to pay for the machine out of pocket?
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Replies to This Discussion
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Permalink Reply by Meg on
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As a health care provider that works a lot with sleep apnea I should know the billing answer but I don't I confess. But, as a provider, I STRONGLY encourage you to work with your home care co and sleep provider to find a solution that works. If you're having problems, there should hopefully be a respiratory therapist somewhere in your system, or maybe someone from the sleep lab who can make some suggestions or help you find more appropriate equipment if there are big issues. If the DME company won't work with you to find a solution, shop around fro a home care company who's focus is respiratory medicine. Last night was night 3 for me with my own CPAP, and the first night I kept it on all night. It does take time to get used to, and it's not unreasonable to work into it gradually. Keep trying!!!
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Permalink Reply by Judy on
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Why would you fib to the person or service that is providing your equipment and to whom you SHOULD be turning to for advice and assistance in acclimating to CPAP therapy? Their RT can't help you if they don't know you are having a problem! They aren't mind readers. YOU are experiencing the problem, YOU SHOULD be contacting them AND your sleep doctor for the assistance you need. We are then here to fill in the gaps as we can.
WHY SHOULD your insurance continue to pay for expensive equipment you are NOT using? Yes, the insurance company can refuse to pay for that equipment and yes, you would have signed paperwork agreeing to be responsible for what insurance doesn't pay.
It is YOUR responsiblity to make this therapy work for you. It is THEIR responsiblity to help you out w/any problems you make them aware you are having. They can't help w/a problem they don't know exists.
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Permalink Reply by Dan Lyons on
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This is a double-edged razor. If the DME is calling based on their concern for you as a patient, you need to be upfront with them. Why aren't you using the equipment? Is there a fitting problem? Is there an anxiety issue? What ever it is, be honest.
If they are calling and hiding the pretext for the call as concern for you, but really questioning your usage as a basis for the insurance report they will file, and they will, as it is required in order for them to receive payment for their service, you may have a problem.
If you are having issues with the equipment, you need to get them resolved quickly. The insurance company will review your compliance based on the information from the data card at some point. Your DME will file the report so they can be paid. If you have perpetuated the lie, they could actually consider criminal charges of insurance fraud (this is a worst case scenario). Not saying that that would occur, but I have seen them institute legal action to recover what they consider as a fraudulent claim.
Remember - You are the one who controls your treatment. Educate Yourself
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Permalink Reply by sleepycarol on
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If they check your data card -- they are going to be very aware you aren't using your machine if you aren't. No getting around it.
Call them tell them you are having problems. Insurance is paying them to help YOU.
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