Diagnosis: Obstructive sleep apnea
Issue under review: Continuous rental of Continuous Positive Airway Pressure (CPAP)
The insurer denied the Continuous rental of Continuous Positive Airway Pressure (CPAP).
The denial was overturned.

The patient is a female with sleep apnea. The patient is reported to have an RDI (respiratory disturbance index) of 9.5. She is reported to be using the APAP (automatic positive airway pressure) machine for 100% of nights over four hours of use, with an average use of eight hours 38 minutes documented on a data download.

Yes, the continued rental of CPAP is medically necessary.

Consistent with plan requirements and standards of care, this patient through their recent data downloads shows excellent compliance with AutoPAP therapy and efficacy in control of her apnea, with average AHI (apnea-hypopnea index) of 0.69 on her last data download. Though the patient had compliance issues early in the use of her device, she is presently compliant, with high efficacy and the equipment remains medically necessary for her use to control her sleep apnea.