Sleep Apnea Patients Must Show PAP Compliance Before Device Purchase or Resupply

if you received a new pap smear to treat your sleep apnea in the last 12 to 18 months, you likely have a device that can be enabled to wirelessly transmit your usage data to your smartphone, your doctor, your medical equipment provider and even your health insurance company.

why? What? what does this mean for patients and their privacy? What are the benefits for patients and their healthcare providers?

Reading: How long does it take insurance to approve cpap

why does my health insurance company care if i use my device?

Health insurance companies will generally cover a Pap smear to treat your sleep apnea if you have proof of your diagnosis from a sleep study; however, more and more insurance companies are paying for those devices on a rental basis rather than paying the full purchase price of the device up front. the rental term can be from 2 months to 12 months. after making the last rental payment, the patient owns the device.

Insurance companies do this because patient adherence to pap smear therapy is not very good. pap smear therapy is challenging, even though pap smears are the most effective treatment for sleep apnea and proper use has been shown to decrease sleepiness, improve daily functioning, and restore memory in those with sleep apnea . several studies show that less than 50% of patients prescribed Pap smear therapy use the device for more than four hours per night.

Insurance companies don’t want to pay for a Pap smear you’re not using.

How does my insurance company know if I’m using my device?

In response to insurance companies’ requirement that you prove you’re using your device before they’ll pay for it, pap device manufacturers have developed ways to more easily obtain that data, called “compliance data” or “usage data”.

These are the most common ways to get the data:

  • smart card. Each Pap device has a data card, or memory card, located inside the device that stores your usage data on an ongoing basis (usually about 12 months of data). it is a small card like the memory card used in a digital camera. the card can be removed (the data is also stored within your device) and sent to your doctor or equipment provider to download the data and generate a report. there is no wireless data transmission, but this requires additional steps, such as mailing in the data card or scheduling an appointment with the equipment provider to download the data.
  • pluggable modem. a separate modem can be purchased and connected to a pap device. uses cellular service to transmit data on a regular basis. modems can be used for a short time or for the entire duration of therapy. data is transmitted approximately one hour after the machine is no longer in use.
  • wireless-enabled pap smear device. Newer devices have built-in modems that use Wi-Fi, Bluetooth, or cellular service (or a combination of them) to transmit your data. Assuming you have access to a wireless signal, the machine will automatically transmit usage data to the patient’s care provider approximately one hour after the machine is no longer in use.
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    With both pluggable modem and wireless devices, if for some reason a wireless connection is not available, data can also be stored on the data card inside the device.

    what information is tracked?

    Data-capable cpap machines collect several statistics pertinent to successful cpap therapy, such as hours the device was worn, time spent sleeping, apnea-hypopnea index (AHI), and rate of sleep. drain. With this information, treatment specialists can monitor a patient’s progress, check adherence, and prescribe changes in therapy as needed. some devices even allow remote troubleshooting, such as checking if the device is working properly and making changes to pressure settings (by prescription only).

    Most insurance compliance guidelines require you to show proof of using your device for a minimum of 4 hours per day on at least 22 days of a rolling 30-day period within the preceding 90 days (in the last 3 months) .

    where does the data go?

    Depends on the type of monitoring device and the manufacturer of your device. At a minimum, the data is obtained by your equipment provider, who bills your insurance to obtain payment for the device. the report will be sent to your insurance company. the data is stored securely by your provider and you have the right to request your medical records, if you wish. Your doctor may also want to see your compliance data to better manage your therapy.

    How often will I need to show proof of compliance?

    This also depends on the requirements of your insurance plan. For several years, many insurance companies, including Medicare, have required proof of use to pay for the rental or purchase of a Pap smear.

    compliance test for replacement supplies

    Recently, insurance companies also require annual proof of use before authorizing payment for replacement supplies. Replacement supplies are the extra masks, pads, filters, and tubing that should be replaced at regular intervals to ensure optimal performance of the Pap smear. replacement supplies are generally shipped by your equipment supplier every 90 days.

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    Again, insurance companies don’t want to pay for equipment you’re not using.

    Efficient treatment or too much information?

    Data-enabled cpap machines could mean more effective and personalized sleep apnea care and an overall increase in compliance. it also requires continuous monitoring of one of the most private areas of a person’s home. what do you think? Do the advantages outweigh the cost in privacy?

    order cpap supplies

    Editor’s Note: This post was originally published in September 2014 and has been edited and updated for accuracy and completeness.

    Other publications that may be of interest to you:

    • will my insurance cover cpap? Coverage FAQs
    • how severe will insurance cover cpap for sleep apnea?
    • safe for bilevel pap smears
    • medicare coverage for cpap and supplies
    • How does the Affordable Care Act treat sleep apnea?
    • previously posted comments on the sleep better blog:

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