CPAPs and BiPAPs (PAP Therapy) – What Does PAP Compliance Mean to Your Insurance Coverage?

More and more insurance companies are requiring that you meet specific utilization criteria when you start PAP therapy.  This utilization is referred to as “compliance.”  The gist of compliance is that the insurance companies want confirmation that you are actually using your CPAP. How do they get confirmation?  The current technology CPAPs contain an SD disk that records your utilization of your CPAP.  It can read whether your mask is on your face or if it has been removed, how many hours it’s been used and additional clinical data.  Your CPAP provider then needs to download the disk and print a report to be used by your sleep doctor and available for your insurance company, should they require it.  If the downloaded report shows that you are not using your equipment, it’s likely that your insurance company won’t pay for it.  Kind of makes sense doesn’t it? The general rule of thumb for qualifying compliance is using your CPAP device a minimum of:

• 4+ hours/night,
• for 70% of the nights (21) during a consecutive 30-day period,
• within the first 90 days of therapy.

  Obstacles to achieving compliance You’ve made it through your sleep study – a unique experience, at best; and are overloaded with information about your sleep apnea diagnosis and the need for PAP therapy.  This can result in some very understandable anxiety which can impact your ability to achieve compliance with your PAP therapy. You may take to PAP therapy like a duck to water!  You’ve been sleep-deprived for so long that the ability to just breathe well and get some quality sleep makes this therapy a welcomed relief to you.  However, some people need a little more assistance with their compliance.  The following are some common issues for the people who do experience difficulty with PAP therapy:

• Creating a new habit
• Claustrophobia
• Mask issues (e.g. hard to fit facial contours, hurts your face, facial hair disrupts mask fit)
• Too much air pressure / Feels difficult to exhale
• Lack of understanding the therapy due to other chronic health issues (i.e. memory loss, lack of concentration, confusion)

  What can Liberty do to help achieve compliance? Our focus is to work with and educate you on an individual basis.  During our set-ups, we offer the realities and facts of what to expect. We are creatures of habit and getting used to this therapy can take time; it’s important to be kind to yourself.  With Liberty as your CPAP provider, you can expect the following service to increase your success in achieving compliance:

• Confidence in how to operate your device
• Phone follow-up to provide encouragement and troubleshooting during the adjustment period
  • Re-instructing the ramp feature (decreases the pressure for a transitory period allowing you to fall asleep while the pressure increases to your prescribed level)
  • Mask re-instruct and fittings – the 3 major manufacturers (Respironics, Resmed and Fisher & Paykel) stand behind their products with a 30-day mask guarantee and/or replacement
  • Wearing your mask and turning on the CPAP while you’re awake will also help with any claustrophobia issues and allow you to accept that you are receiving air – this helps eliminate any sense of alarm  in the middle of the night when you become aware of the air pressure

Additionally, Liberty has an open office/door policy help to calm any anxieties or reservations while completing your first 90 days of therapy – and continues through the life of your CPAP therapy. Your success and health is our success.