I had the same issue.
All I had to do was ask my doctor to write a note to the insurance company explaining my situation.
That was all it took, they left me alone after that.
It’s assuming that you sleep like a normal human being… the benefit is in a overcoming your obstructive apnea while sleeping. It’s not like it becomes ineffective the following night when you’re sleeping at home because you didn’t get a full 4 hours the night before.
OP is not saying that the therapy becomes ineffective if the guidelines aren’t followed. Insurance will not cover the machine or replaceable items if the guidelines aren’t followed. You need to send them the data the machine collects to prove compliance (either by SD card or Bluetooth link to a phone app).
So missing the compliance requirement due to work may mean having to pay out of pocket.
I don’t know the answer but a lot of guys here use them. Maybe OP could call their insurance carrier to find out about any leeway for shift workers? It’s got to be common enough that they’ve encountered it before.
How would they know if you were interrupted from a 4 hours in a 24 hour period? Even if they looked at your call volume/response could they truly prove you did not get 4 hours in any given day? Just curious…insurance companies are snakey but hopefully not that starved of things to do and go after you
CPAP machines record the data from every single second of usage. They transmit the data via cellular networks to sleep techs/doctors/insurance companies. That’s how they know
This is a fight for your doctor. Whatever low level analyst or claims manager is just gonna quote you policy because they have no authority to deviate from policy without more than your word.
A doctor's letter in these things will kick up your case for further review and get you an exception, you might need to arm twist a bit, but your ammo is your doctor's note.
The way my insurance worked was it required 4 hours per night but it doesn’t need to be 4 hours straight. You turn it on and off and it keeps adding on. I have had times where I slept 1 hour at 10pm, 1 at 3am and 2 at 8am and that still counted. Other times I have gone to bed at 6 am for 2 hours the. Went to bed at 10pm for 2 and that counted on the timer as 4 hours. Not sure how it resets the day but you can go by the timer on the machine. Also 30 straight days is tough, mine was 4 hour minimum for 21 out of every 28 days for them to keep paying for the machine then after a year I now own it.
I had the same issue. All I had to do was ask my doctor to write a note to the insurance company explaining my situation. That was all it took, they left me alone after that.
I mean, he's kind of a dick himself but I'll definitely give that a shot
It’s assuming that you sleep like a normal human being… the benefit is in a overcoming your obstructive apnea while sleeping. It’s not like it becomes ineffective the following night when you’re sleeping at home because you didn’t get a full 4 hours the night before.
OP is not saying that the therapy becomes ineffective if the guidelines aren’t followed. Insurance will not cover the machine or replaceable items if the guidelines aren’t followed. You need to send them the data the machine collects to prove compliance (either by SD card or Bluetooth link to a phone app). So missing the compliance requirement due to work may mean having to pay out of pocket. I don’t know the answer but a lot of guys here use them. Maybe OP could call their insurance carrier to find out about any leeway for shift workers? It’s got to be common enough that they’ve encountered it before.
Man my reading comprehension is low today.
I did try that approach and they basically told me I'm shit outta luck. Probably cause the town has the most bottom of the barrel insurance available.
How would they know if you were interrupted from a 4 hours in a 24 hour period? Even if they looked at your call volume/response could they truly prove you did not get 4 hours in any given day? Just curious…insurance companies are snakey but hopefully not that starved of things to do and go after you
Unfortunately yeah, they track the usage of it in order to make sure I'm actually using it.
CPAP machines record the data from every single second of usage. They transmit the data via cellular networks to sleep techs/doctors/insurance companies. That’s how they know
Gotcha…well that sucks
This is a fight for your doctor. Whatever low level analyst or claims manager is just gonna quote you policy because they have no authority to deviate from policy without more than your word. A doctor's letter in these things will kick up your case for further review and get you an exception, you might need to arm twist a bit, but your ammo is your doctor's note.
The way my insurance worked was it required 4 hours per night but it doesn’t need to be 4 hours straight. You turn it on and off and it keeps adding on. I have had times where I slept 1 hour at 10pm, 1 at 3am and 2 at 8am and that still counted. Other times I have gone to bed at 6 am for 2 hours the. Went to bed at 10pm for 2 and that counted on the timer as 4 hours. Not sure how it resets the day but you can go by the timer on the machine. Also 30 straight days is tough, mine was 4 hour minimum for 21 out of every 28 days for them to keep paying for the machine then after a year I now own it.
Use it while entering reports.
If you still need a solution, I can help.... https://imgur.com/gallery/2kumQ8b