Compliance

What is “Compliance”?

Your insurance company requires that we obtain a “compliance download” from your CPAP / BiPAP unit within 90 days of the start of your PAP therapy. This information is required in order for your insurance company to pay for the unit.

How Do You Prove “Compliance”?

We schedule a “download” appointment that consists of one of our therapists removing a small memory card from your unit and extracting the recorded data using a special computer program. Once we have the data, we will review it with you, and return the card to your unit.

How Long Do I Have to Prove That I’m “Compliant”?

We essentially have a 90 day window to prove to your insurance company that you are using your PAP device at least 4 hours per night for 30 consecutive days. We start by scheduling this download appointment 30 days after you start therapy.

- If unable to prove compliance at the 30 day mark, we will schedule another appointment at the 60 day   mark.

- If unable to prove compliance at 60 days, we will make one more attempt, and schedule an appointment at the 90 day mark.

- If unable to prove compliance at 90 days, your insurance company will stop payment on the machine and you must either return the unit or be financially responsible for all charges.

*If you carry Medicare, your insurance company also requires you to have an office appointment with the physician who ordered your CPAP / BiPAP unit. This appointment must take place after we have proved your compliance but must be done within the 90 day window. Again, without this appointment, your insurance company will not pay for your unit, and you will be responsible for all charges.

Generally, once we prove “compliance” to your insurance company, we will not have to do it again. Most insurance companies will rent the unit for several months then purchase it for you. Once purchased, your insurance company will not cover a new machine for 5 years (in which case you will need to prove “compliance” again on new unit).