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

If you’ve received a new PAP device to treat your sleep apnea in the past 12-18 months, you likely have a device that can be enabled to wireless transmit your usage data to your smartphone, your physician, your medical equipment provider and even your health insurance company.

Why? How? What does this mean for patients and their privacy? What are the benefits for patients and their healthcare providers?

Why does my health insurance company care if I use my device?

Health insurance companies will usually cover a PAP device 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 upfront. The rental term can be anywhere from 2 months to 12 months. After the last rental payment is made, the patient owns the device.

Insurance companies do this because patient adherance to PAP therapy is not very good. PAP therapy is challenging, even though PAP is the most effective treatment for sleep apnea and proper usage is proven to decrease sleepiness, improve daily functioning and restore memory in sleep apnea sufferers. Several studies show that less than 50% of patients prescribed PAP therapy use the device more than four hours per night.

Insurance companies don’t want to pay for a PAP device that you aren’t using.

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

In response to the insurance companies requirement that you prove you are using your device BEFORE they will 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 of obtaining the data:

  • Smart card. Each PAP device has a data card, or memory card, located inside of the device that stores your usage data on a rolling basis (usually around 12 months of data). It’s a small card like the memory card used in a digital camera. The card can be removed (the data is also stored inside of your device) and sent to your physician or equipment provider to download the data and generate a report. There is no wireless transmission of data, but this does require additional steps such as mailing in the data card or scheduling an appointment with the equipment provider to have the data downloaded.
  • Attachable modem. A separate modem can be purchased and attached to a PAP device. It uses cellular service to transmit the data on a regular basis. Modems can be used for short period or for the entire length of therapy. Data is transmitted about an hour after the machine stops being used.
  • Wireless-enabled PAP device. The newest devices have built in modems that use Wi-fi, Bluetooth or cellular service (or a combination of them) to transmit your data. Assuming that it has access to a wireless signal, the machine will automatically relay usage data to the patient’s care provider about one hour after the machine stops being used.

With both the attachable modem and the wireless-enabled devices, if for some reason a wireless connection is not available, the data can also be stored on the data card inside the device.

What information is being tracked?

Data-capable CPAP machines collect several statistics pertinent to successful CPAP therapy, such as hours the device was used, time spent sleeping, apnea-hypopnea index (AHI), and leak rate. With this information, treatment specialists can monitor a patient’s progress, check his compliance, and prescribe changes in therapy as required. Some devices even allow for remote trouble-shooting like checking to see if the device is working properly and making changes to the pressure settings (by prescription only).

Most insurance compliance guidelines require that you show proof of using your device for a minimum of 4 hours per day at least 22 days out of a consecutive 30 day period within the preceding 90 days (in the past 3 months).

Where does the data go?

It depends on the type of monitoring device and the manufacturer of your device. At the very least, the data is obtained by your equipment provider who is billing your insurance to obtain payment for the device. The report will be sent to your insurance company. The data is securely stored by your provider and you have the right to request your medical records, if desired. Your physician may also wish to see your compliance data in order 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 usage in order to pay for the on-going rental or purchase of a PAP device. 

Proof of compliance for replacement supplies

Recently, insurance companies are also requiring proof of usage on a yearly basis before they will authorize the payment of replacement supplies. Replacement supplies are the additional masks, cushions, filters and tubing that must be replaced at regular intervals to ensure optimal performance of the PAP device. Replacement supplies are usually shipped to you by your equipment provider every 90 days.

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

Efficient treatment or Too Much Information?

Data-capable CPAP machines could mean more effective, tailored sleep apnea care and a general increase in compliance. It also requires continual 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?

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

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Comments posted previously on the Sleep Better Blog:

Jo Sepulveda

4/15/2015, 8:29:25 PM

Cpaps that transmit data are an invasion of privacy

4/15/2015, 9:12:10 PM

It’s not hard to understand why people feel that way! This practice presents an important issue to the changing health care industry about whether efficient treatment or patient privacy is more important.

Katharine Chambers

5/8/2015, 7:02:38 AM

I believe it is an invasion of privacy too. I think the data card is enough. You should voluntarily give the card your doctor to show compliance. I think the doctor should see the information first before it is given to a company that will do who knows what with. This is a real concern.

5/8/2015, 7:05:51 AM

Hi, Katharine. I agree, it’s a huge concern. The modems in the devices we use can be turned off or put in “airplane” mode.

Jeff Greer

7/3/2015, 2:53:16 PM

The durable medical equipment supplier can download the minute by minute data, not just the summary data. In my case, the DME changed my settings and then called me after the fact, no discussion, just do as I say!

7/9/2015, 3:12:11 PM

The way PAP data typically works is that providers can see trend data, not minute by minute data. Any changes to the device’s settings should involve the patient, especially remote changes to device pressure.

Rose Rose

12/31/2015, 4:58:22 AM

What about the health dangers in just having a modem or wireless transmitter that close to your head for 10 hours a night. Even if its turned off.

1/4/2016, 3:25:20 PM

Hi Rose. That’s a valid concern. It’s the similar sleeping with a cell phone near (or in) your bed that’s powered on but the cellular and wifi receivers are turned off. The PAP machine will operate as it is plugged into the wall and the data will be stored locally on a memory card. Another option may be longer tubing to increase the distance between your head and the device. Standard tubing is about 6 feet long but you can get longer 10 ft tubing.

Dave Jones

1/30/2016, 7:29:04 AM

As a sleep service provider, remote monitoring is a more efficient way of obtaining patient compliance and quality of treatment without the need for the patient to undertake a time consuming and sometimes costly journey to the sleep service, which should be a critical essential part of the treatment pathway. The benefits for patients who have mobility issues or transportation issues are immense. Of course permission for the service to monitor the data must be requested by the service before monitoring commences. In UK we are the leaders in applying remote monitoring, and 99% of our patients love it. Compliance rates have improved and treatment drop out rates are significantly reduced. Early intervention and communication with patients has resulted in increased patient satisfaction with the service. From a business point of view remote monitoring has reduced DNA rates and Increase work efficiency. Used in a controlled professional environment remote monitoring is extremely safe and patient friendly. For those patients who want timely professional help remote monitoring is the best way to go.

2/1/2016, 8:39:28 AM

Hi, Dave. That’s good to hear. We’re embracing the technology because of the opportunities for early intervention and communication. It’s also much less of a hassle than mailing SD cards back and forth. Thanks for sharing.

7/13/2016, 9:07:04 PM

The card data collection is not accurate. My data card said I did not use the machine for 49 out of a 180 day period. I am a degrees Chem. engineer out of Purdue with 35 years experience in industry and I know for a fact I have missed 4 days over this period. These chips are B.S. .

7/14/2016, 5:13:14 PM

Hi Pat, we’d be happy to take a look at your card for you. It might be time for a new device (you can check with your insurance or your DME provider) that has wireless monitoring. We’ve had lots of issues with corrupted data cards and are relieved to use the new devices. Good luck! -Julia

Richard Taylor

8/20/2016, 9:31:47 AM

I have a problem with the invasion of privacy with this system and the overall trend in society now to use remote monitoring with the use of cameras, data and voice recording and so on. As for “mandatory compliance” how about a novel idea (ASK and TRUST) the patient if they are using their device and if they have any questions or issues with the system. Only a very small percentage of the patients should want or need remote monitoring. When I finally take my last breath and leave this life I would hope that my family will know before some stranger in a remote location sees the data that is transmitted to them. I have integrity and I’m honest don’t treat me with disrespect and keep your remote surveillance out of my life. This technology and the personnel to man it only increases the cost to all of us.

8/23/2016, 4:57:23 PM

Hi Richard. I totally understand your concerns. The ultimate goal should be helping patients use the devices to improve their health. While I think that some of the new technology can really help to improve patient outcomes, it’s really the healthcare provider who can make the most difference. Education and support are key! Good luck with your therapy.

Pat Fisken

9/2/2016, 11:27:45 PM

I have been using a CPAP successfully for about 10 years. This spring I got a new machine that monitors remotely and also has a card to monitor. I have had great compliance always. But lately I have been waking up in the middle of the night, I believe because of the high EMR that is emitted by the wireless monitoring device. I am electro-sensitive, and I think that this wireless feature is decreasing my effective usage. I am going to speak with my health provider to see if this new ‘convenient’ feature on my CPAP machine can be disabled. The card had worked well for the last 10 years! I now feel like my therapy is compromising my health (as well as invading privacy).

Julia Rodriguez

9/3/2016, 2:06:55 PM

Hi Pat. I understand your concern. I believe that most of the devices that transmit via cellular only transmit data in the morning about an hour after you stop using it. I don’t think it’s emitting any signal other than during transmission, but it’s a good idea to check with your manufacturer. Another option is to put it in “airplane” mode and only turn on the wireless transmission once a week or so. That way you can have the benefits of remote monitoring but not risk the emissions. Good luck.

Comments

  1. Ginger Reply

    I believe in being able to access and evaluate my own data. Also to find out who is getting a copy of my data. I had no idea that the insurance company was monitoring it. How is this data kept secure? Or is it?
    Ginger

    • Julia Rodriguez Reply

      Hi, Ginger. Great point and relevant concern. Your insurance company has access to all of your medical records, including the compliance data captured by your CPAP. The insurance companies, healthcare providers and equipment providers are expected to maintain the highest levels of security with this data. The Health Insurance Portability and Accountability act of 1996 requires that providers keep data private and secure. You can find out more about HIPAA here: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/

  2. Bo Reply

    Does anyone know if the DME or medical supply company can remotely disable your machine. I have a ResMed air sense 10.

    • Julia Rodriguez Reply

      Hi, Bo. An equipment provider can change your pressure or humidification settings but cannot disable your machine. They shouldn’t make any changes without your doctor’s approval and YOUR permission.

  3. Jimmy Whittle Reply

    Thank you. My air sense 10 recently just powered off and won’t come back on so I was just wondering.

    • jodi Reply

      They can and do turn off your machine! They cut mine off the other day- it’s taking me longer than their cut off time to get used to this thing!

  4. Sweetpea Reply

    My friend turned down using a CPAP because of this invasion of privacy. He has sleep apnea but doesn’t want big brother in his bedroom!

    • Julia Rodriguez Reply

      I totally understand his concerns. Your friend can change the settings on his device to “airplane” mode, just like a cell phone, so it’s not transmitting data. Of course, if his insurance requires proof of compliance, he will need to provide some data. These new devices with wireless modems also have SD cards, so he could obtain the data that way without using the modem. I hope he finds a way to start his therapy soon! -Julia

  5. Punkin Pi Reply

    Nobody sees any of your medical records except your doctor, NSA, and a thousand Russians. Orwell’s ‘1984’ was nothing compared to this!

  6. Dennis Reply

    I just started using a airsense 10 and am so happy with the results! However when they brought it to me they only brought the nose pills wicch I cant use because my nose was broken at a early age and not enough airway to breath. the last time I was in hospital with a mask, when discharged let me have the mask since they would only throw away. I have been using this (disposable mask for a couple weeks now and need a real mask for my unit. I am stretching the end ti use it and will will soon ruin the hose. Who do I contact about getting a real mask and giving back all pillow supplies?

  7. Bob Reply

    I see the point of not paying for something that is not used. But on the other hand, if you use it part time, you gain some benefit. This is part of the trend from obama of penalizing patients who do not meet goals. If you do not do the therapy the way we want, you lose all benefit. Now, is the insurance company a payor or a medical provider?

    • Julia Rodriguez Reply

      Hi Bob. I agree that penalizing people for not meeting a standard is dangerous. Using CPAP requires behavioral changes and penalties/threats of losing the device may not work for all patients. We’ve seen an increase in patients who lose their device after the first three months for not meeting usage requirements. Also patients who are somewhat “compliant” and truly need replacement supplies, but can’t get them covered through insurance. It’s a tough one.

    • Wendy Reply

      Hi Bob,

      I don’t think that this is penalizing the patients for not using therapy the way it is prescribed. I think it protects insurance companies from having to pay for therapy that the patient is not using. After all, every penny wasted is a penny more on our insurance premiums. There really is no reason for an insurance company to pay to have expensive CPAP supplies sent to us if we aren’t going to use them.

  8. Rebekah Reply

    I am just starting my cpap and really struggling. I have no desire to give up trying to use it, but i need a break from it sometimes after wearing for a while. If i dont wear it, but have it running still for about 30 minutes..does it show on record its not being used? I have to meet my required time to wear it each night.

    • Wendy Reply

      Hi Rebekah,

      By now, I hope you have found a way to sleep comfortably with your CPAP machine. To answer your question about turning the machine on for 30 minutes while not actually using the machine in order to get a record of use – you may get more than what you bargained for! One of the measurements the CPAP compliance looks for is air leakage. Normal air leakage would probably never go above 10%. If you were to simply run the machine without wearing the mask, your leakage would be at 100%. That would signal to the supplier and your insurance company that you either have a serious mask problem or more than likely are running the machine without the mask on your face. This could trigger all sorts of things like: having a rep come to your house to check your cpap fit, forcing you to go to a sleep study clinic to show that your mask really leaks that much, and/or a refusal from the insurance company to pay for supplies. Even if none of that were to happen and they didn’t check for leakage (which they do), you’d still have to be on the machine for no less than 4 hours a night for 22 out of 30 days per month.

      CPAP is the best treatment for sleep apnea and could very well save your life. I was unaware that I had sleep apnea and had a stroke in my mid 30s because of it. You’ll want to do everything you can do to treat your apnea. I do hope that you have been able to get through the adjustment period.

    • jodi Reply

      I’m having the same issues! Yes it knows when it’s not on your face and not being used

  9. Rad McShane Reply

    I got a cpap probably 8 years ago and never really used it. Can I just throw it away? I called my insurer and they said to contact my equipment provider but I forgot who it even was.

  10. Leon McGuire Reply

    My medical supplier showed up with a used CPAP machine at my orientation appointment, it never occurred to me to ask if I was receiving a new machine. My insurance is supposed to rent this used machine for nine months with my co-pay before I supposedly own it. Is it protocol or ethical to provide used machines? Can I demand a new one? If I wanted a used machine I’m sure I could find one on E-bay or Craigslist much cheaper.

  11. john Reply

    can my company demand to see nightly use of my cpap machine?Do I have to give them that much access?

    • Wendy Reply

      Hi John,

      The answer to your question is a yes and no. Yes, your insurance company can demand your stats, and no, you don’t have to give them the stats. This however, will more-than-likely result in their refusals to pay for new supplies or even the equipment rental. My CPAP cost in the upwards of $1,400 and then my re-supplies conservatively cost around $1,600/year. Even as a pro-privacy advocate, I can’t see how I could legitimately expect my insurance company to pay for something that they can’t prove that I use on a regular basis.

  12. Wynette Reply

    Help! My husband just got an APAP machine Friday afternoon with the 30 day trial. We are going on a cruise tomorrow and won’t have WiFi access. Do we need to purchase it? Or will the Bluetooth from his phone catch up at ports? I’m not familiar with how this collects and turns on data. Thank you in advance for any help.

  13. Heather Dornan Reply

    50% COMPLIANCE among sleep apnea patients???That is a very low percentage!!!! I truly believe that in order to get a better compliance success rate they need to try a different approach. The manufacturers of CPAP equipment are making the best of the best. This includes machines, masks, filters, headgears etc. But from my recent and new experience with CPAP, this is not the issue. It is a matter of allowing a person to GRADUALLY start getting used to using a CPAP machine and all of it’s components. How can anyone expect a person to completely change the way they have slept all of their life instantly???? Yes, they tell you to wear the mask during the day with or without the machine turned on. Then they tell you to just wear it while watching TV and so on and so on. Then you are expected to wear this mask over your face or which ever mask you prefer while you sleep every night! They really ought to look into HOW to get more compliance instead of making all these new and expensive masks etc. I think people need more time to adjust to using CPAP. It needs to be a gradual thing. Maybe there should be a trial phase before compliance actually begins. A person would need to practice using the mask provided and it would need to be worn for an hour the first day with the machine on. Two hours the next day and work their way up to 4 hours a night. So by the end of the “trial week” they are at least some what ready to wear it while asleep. To expect someone, who has been sleeping without devices and masks, to suddenly change is absolutely absurd. Every person is different but I believe that compliance percentages could rise if the time allowed to using CPAP is a bit longer or in a progressive and gradual manner rather than throwing a HUGE change into someone’s sleeping habits. Especially since most of us have been sleeping a certain way all of our lives.

    • Ron Reply

      You’re so right that improving machines & masks has not improved cpap compliance rates for decades. One thing that has been “missing” all along is a COMPLETE way to manage the hose. It causes sleep interruptions and mask failures and keeps everyone in the bed awake. Simply draping it over something or hanging it on a hook is not the answer. The Hozer has a flexible arm that floats the hose so it follows overhead to keep it completely out of the way while “delivering” just the right amount of hose at all times. The hozer is what has been missing from the beginning!

  14. Sandy Reply

    Privacy is one thing. Internet security is another. Security researchers have discovered that many “Internet Of Things” devices have horrible security, and are subject to all sorts of hacking, malware, virus, information stealing, etc. Although manufacturers may say “Security is our main concern!”, evidence shows this is not the case. For example, a study showed that about 10,000 internet connected cameras were invaded by a “botnet” controlled by criminals. Allowing a machine whose security is poorly implemented access our *health information* is a concern of mine, and should be of everyone’s.

    • Jennifer Capobianco Reply

      I SOOOO agree with you. I am on my second attempt in 5 years to use a cpap and struggling again. The last time the insurance company peppered me with threats of taking it back while I was waiting for a new mask and I was so annoyed I said just take it. This time I am getting nauseous, have to turn it off after a couple hours and am not using it 4 hours a night. Here we go again. The phone will be ringing soon. I had to pay half up front for the machine and pay $1600 a month for my health insurance with a high deductable as both my husband and I are self employed. I have severe apnea according to the study and although I don’t fit the mold ( young female no weight issues) my two brothers have it also and cpap and swear by it. I want this so badly to work for my health and my husbands ears but man its just a racquet. And now they are in my bedroom with me??? Is there a black cpap market where I can buy one myself and take my sweet time getting used to it?

  15. Carol Reply

    As a pharmacist, I’m visiting with a friend whose husband has a new CPAP. My friend was horrified and repelled by the idea that the CPAP would be collecting ANY information from a human being who is in a bedroom–or in any room where he (and by extension, his sleeping partner) have a legal expectation of privacy.
    If someone was a voyeur spying on sleeping human beings, he (rarely she) should be caught, arrested, and the full force of law imposed on this predator. This predator is a sex offender. Your CPAP will give information that a rational human being rightfully expects will be completely private.
    Sexual privacy of TWO persons is violated, since CPAP use will be interrupted, and the breathing rate will change.
    My medical assessment of this?
    CREEPERS, KEEP YOUR SNIFFING OUT OF THE BEDROOM.

  16. Carl Gromatzky Reply

    I have been using my new CPAP machine for just over a week now. I received an email from the provider of the machine, actually her email said she is a Compliance person. She stated that my data indicated that I am not using my device the minimum of 4 hours per day per insurance requirements. Now I have found this web site with information that indicates my insurance company can demand this VERY PRIVATE data concerning my sleep habits.

    I understand that insurance companies have access to my medical records, but the do NOT have access to my conversations with my Doctor, nor how I take my medicine. Can an insurance company ask for a diabetic to prove they are taking their insulin correctly and the correct amount each day and if not refuse to pay for it?

    How is that any different then how I use my CPAP device??!! This is truly INVASION of privacy and I am VERY upset about it to the point of being very angry about it. I plan on contacting my insurance company and having a very crucial conversation with them.

    If anyone has any ideas about what else I can do about this please reply to this post. This is very very upsetting to me.

  17. jodi Reply

    How can I turn my cpap back on once they cut it off? This is WRONG! It does take a good while to get used to this thing- I hate it!

  18. Jennifer Capobianco Reply

    When you find out please let me know…grrrrr

  19. Nyla Rounds Reply

    I have found cpap machines online for way less than the $1400 someone mentioned above. My husband is probably going to need one after his sleep study and I am thinking if we buy through online vendors….cpap.com has them from $369 and up…..and pay for it ourselves, we will not have to provide anyone with any monitoring. I had no clue this was a thing until the video consult nurse gave my husband told him the insurance (bcbs MI) required monitoring. That just adds to the cost because someone is going to bill the insurance for that monitoring. More money for someone…..what a racket.

  20. Dan Toura Reply

    It’s all a big racket. These machines are not THAT expensive. And a “Company” buys a bunch of them, real cheap. For this “Company” to make money, they charge the hapless “victim” many times over what they paid for it. They say “Insurance” will pay for it. The catch is that the insurance companies are wise to “FRAUDULENT” payments to anyone who bills them. And they want “proof” that SOMEBODY is actually using it. The “Compliance Contact” is the “Double Agent Spy”. The CPAP Co. wants to get paid. The Ins. Co. wants proof of it’s use. Or it won’t pay. On the “Bright, cheery, happy” side, people DO want to solve their sleep Apnea disorders. On the “Quasi-sleazy, money greedy” side, The “Company” knows Insurance will pay the outrageous price of the machine, if they provide PROOF. This, in itself, is FRAUD. In the form of OVER CHARGING patients. This over-charge is what’s wrong with ALL insurance coverage prices today. The only way I see fixing this problem is filing class action suits to END CPAP machine businesses altogether. If someone WANTS to better their own health with a machine, let them buy it off a store shelf, at a reasonable cost. Then THEY can decide if it’s worth the effort and expense to continue using it. We’re NOT stupid. (As one quoted, who we all know as one of the main architects of “The Affordable Care Act”)

  21. Adam Reply

    Hi i have been using RESMED CPAP machine for a few months now i think i use it very regularly my wife can testify to that fact ,i recently got a call from the cpap company they want to take back machine for noncompliance i was like what!! i use it very regularly and only missed probably 1 night in 30 days and its on for more than a couple of hours ,but am told i only had 36 hours out of 90 which is very ridiculous think theres a fault with the machine ,i need that machine cant give it back!!

  22. Tasha Reply

    I have been using mu CPAP for about a year and a half. I am in complete compliance and am so happy. I am sleeping better than I have in years. I have severe sleep apnea. I think it is hilarious that everyone is so afraid of the privacy. It is only managing your breathing, not video taping what you do in the bedroom. If you’re compliant, you shouldn’t have anything to worry about. Why should insurance pay for something you are not using? I have missed a day or two because of sinus issues but my dr is proud of how compliant I have been. You should uses it to avoid health issues. I didn’t want a stroke at 36. I can’t believe all the whining about privacy. Again it is not video taping you!

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