Sleep Apnea Patients: Usage Compliance and Insurance Requirements

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If you suffer from sleep apnea, you need to understand CPAP usage compliance and insurance requirements for your treatment. 

Sleep apnea affects nearly one in ten Americans, and many use CPAP machines to treat their symptoms. A CPAP device can help you stay asleep and breathe more freely throughout the night, alleviating common symptoms such as snoring, headaches, fatigue, and difficulty focusing. When left untreated, sleep apnea can dramatically affect your body, impacting your memory and weight, and bring on chronic diseases such as diabetes.

If you qualify for CPAP treatment, many insurance companies authorize a limited 90-day trial period for the therapy. During that time, you will have to demonstrate CPAP usage compliance to meet insurance requirements for continued coverage and to avoid additional out-of-pocket expenses.

What is CPAP usage compliance?

Once your insurance company agrees to cover the cost of your CPAP device and supplies, you are required to prove that you are actually using it. CPAP usage requirements for insurance vary by insurer, but it is typically measured by how often you use your device. For example, Medicare requires you to use your device at least four hours every night for 70% of the time during a 30 consecutive day period. It is also common for specific plans to require follow-up appointments with your provider to discuss treatment and determine whether you have met your CPAP usage requirements. To ensure you remain compliant and do not lose coverage, you must follow the specific guidelines of your insurer.

Use your CPAP device regularly

Many people have a hard time getting used to CPAP therapy. In fact, 46 to 83% of patients with obstructive sleep apnea are non-compliant with treatment. CPAP has some initial challenges—properly fitting your mask, getting used to the device’s sound, and adjusting to the air pressure—but the benefits far outweigh the drawbacks. Following your practitioner's prescription and treatment plan is essential to remaining compliant.

Make adjustments as needed

It is important that you maximize your comfort level to maintain a regular treatment schedule. Many CPAP users experience pressure leaks, dry mouth, or other side effects when first beginning therapy. If you experience any issues, talk to your practitioner about adjusting your setup to determine what works best for you.

Try the "ramp" setting

A common problem CPAP users experience is the high air pressure forced into the airways. Fortunately, many CPAP machines include a ramp setting that starts at lower air pressure and gradually increases throughout the night. This progressive process allows you to get comfortable and relaxed while falling asleep.

Confirm your CPAP usage compliance with Lincare

Our sleep experts will contact you to monitor your progress during the first 90 days of treatment. Your insurance requires proof that you use your new device at least 4 hours per night. The wireless modem in your device allows us to collect your sleep data and verify your therapy compliance. If, at any time, you have questions or concerns regarding your CPAP therapy, contact our Lincare experts 24/7 for answers and assistance.

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