you snooze, you lose: how insurers dodge the costs of popular sleep apnea devices
It was watching him without his knowledge.
From his bedside, when he used the device, the device was being followed, not only to his doctor, but also to the manufacturer of the machine, the medical supply company and his health insurance company are provided.
Schmidt, an information technology expert from Carrollton, Texas, was shocked.
\"I don\'t know they will send my message by telegram.
Schmidt, 59, suffers from sleep apnea, a condition that causes him to have a worrying interruption in his breathing at night.
Like millions of people, he relies on constant channel positive pressure, that is, continuous airway ventilation, a machine that flows warm air into his nose while he sleeps, keeping the airway unobstructed.
Without it, Schmidt would wake up hundreds of times a night;
Then, during the day, he doze off at work, sometimes while driving, even when he is sitting in the toilet.
\"I can\'t keep my job,\" he recalls . \".
\"I can\'t stay awake.
\"He said the ventilator saved his career, maybe even his life.
As many people find out, life
Medical insurance companies often track whether patients use the device.
If not, the insurance company may not provide insurance for the machine or the supplies with it.
And, in the face of the popularity of CPAPs
About $400 to $800-
They need to replace filters, masks, and hoses, and health insurance has deployed a range of strategies that may make treatment more expensive and even impossible to price.
Patients were asked to rent CPAPs for a much higher price than the equipment retail price, or they found that the supply would be much cheaper if they didn\'t have insurance at all.
Experts studying medical costs say the insurance company\'s persistent airway ventilation strategy is part of the industry\'s shift in the cost of widely used treatments, equipment, and testing to unsuspecting patients.
\"Doctors and providers no longer control the drug,\" said Harry Lawrence, owner of Advanced oxygen compounds.
Med Services, a New York company that provides ventilator supplies.
\"Strictly speaking, it\'s an insurance company.
They have the final say.
Insurance companies say their concerns are reasonable.
Masks and hoses can be cumbersome and noisy, and studies have shown that patients in about 1 out of 3 do not use CPAPs as instructed.
But the practices of these companies have sparked lawsuits and concerns from some doctors who say that the policy of restricting the use of machines could have serious or even fatal consequences for patients with serious diseases.
Privacy experts are concerned that data collected by insurance companies may be used to discriminate against patients or increase their costs.
Excessive sharing of Schmidt\'s privacy issues began the day after he registered a new ventilator with his manufacturer ResMed.
He chose not to accept any further information.
But the next morning, when a lively email arrived in his inbox, he barely erased sleep from his eyes.
He praised him for completing the treatment for the first night.
You won the badge for yourself!
Said in the mail.
Then there was an exchange with Medigy, his supply company: Schmidt praised the company by email for the \"professional, kind, efficient and competent\" technicians who installed the device.
A Medigy representative wrote back to thank him and then added that Schmidt\'s machine \"did a good job of keeping your airway open \".
\"A report detailing Schmidt\'s use was attached.
Schmidt was shocked to complain to Medigy and learned that his data was also shared with his insurance company Blue Cross Blue Shield.
He knew that his old machine had followed his sleep because he had brought its removable data card to his doctor.
But this new invasion of privacy is different.
Is it encrypted when data is transferred to protect his privacy?
What else did they do with his personal information?
He filed a complaint with the Better Business Bureau and the federal government, but did not succeed.
\"My doctor is the only one who has the right to get my data,\" he wrote in a complaint . \".
A Blue Cross Blue Shield spokesperson said in an email that it is standard practice for insurance companies to monitor sleep suspension patients and refuse payment if they do not use the machine.
Privacy experts say sharing data with insurance companies is allowed under federal privacy laws.
A representative of ResMed said that once the patient agrees, it may share the encrypted data it collects with the patient\'s doctor, insurance company and supply company.
Schmidt returned the new ventilator back to the model that allowed him to use the removable data card.
His doctor can verify his compliance, he said.
Luke Petty, Medigy\'s operations manager, said many pap users had expressed anger at companies like him.
Thousands of online complaints.
But he says insurance companies have set prices and rules that suppliers follow so they can get paid.
\"Every year it\'s a new hurdle for patients, a new trick, a new game,\" Petti said . \". A sleep-
The American Sleep Apnea Association estimates that about 22 million Americans suffer from sleep apnea, although it is not usually diagnosed.
The number of people seeking treatment increases with awareness of the disease.
This is a potentially serious disease that, if not treated in a timely manner, can lead to a risk of heart disease, diabetes, cancer and cognitive impairment.
Ventilator is one of the only effective treatments for many patients.
The exact numbers are hard to get, but ResMed, a leading equipment manufacturer, says it is monitoring ventilator usage in millions of patients.
Sleep apnea experts and medical expense experts say insurance companies deal with flooding by forcing patients to prove they are using this treatment.
Due to the discomfort of wearing masks and connecting with noisy machines, it is difficult for many patients to adapt to night use.
Medicare, a government insurance program for the elderly and disabled, began demanding ventilator \"compliance\" after a surge in demand \".
Between 2001 and 2009, medical insurance payments for personal sleep research almost quadrupled to $0. 235 billion.
Many of these studies have prescribed nasal congestion.
According to the medical insurance rules, patients must use the ventilator for 4 hours per night for at least 70% of any 30-30 nights
One day within three months of getting the equipment.
Medical insurance requires doctors to record the adherence and effectiveness of treatment.
Sleep apnea experts believe that the requirements for medical insurance are arbitrary.
But private insurers quickly adopted similar rules to verify usage with data on patient machines.
Whether or not they have knowledge
Kristine Grow, spokesman for the American trade association Health Insurance Program, said it is important to monitor the use of the ventilator, because if patients do not use these machines, a cheaper treatment may be a smarter one
Monitoring patients also helps insurance companies advise doctors on the best treatment for patients, she said.
When asked why insurance companies don\'t just rely on doctors to verify compliance, Grow says she doesn\'t know. Rent or buy?
Many insurance companies require patients to pay the monthly rent, not just the cost of the ventilator. Dr.
Oliver Jacobs, an expert in sleep apnea at the ENT and Allergy Society and an assistant professor at Mount Sinai Hospital in New York, said, his patients often pay rent for one year or more before they reach the price set by the insurance company their CPAPs
But because of the patient\'s deductible
The amount they have to pay before the insurance starts-
At the beginning of each year, he said, they may pay the full rent for most of the time.
Patients and doctors say the rent may exceed the retail cost of the machine.
Alan Levy, a lawyer living in Rahway, New York. J.
By buying a personal insurance plan now.
In 2015, insurance for the medical Republic of New Jersey closed down.
When his doctor gave him a ventilator, the company that provided his equipment at the home medical company told him that he needed to rent the device for $104 a month for 15 months.
The company told him that the cost of continuous respiratory therapy was $2,400.
Levy said he wouldn\'t be worried if his insurance paid for it.
But Levy\'s plan requires him to reach a $5,000 deductible before the insurance plan pays a penny.
So Levy checked it online and found that the actual cost of the machine was about $500.
Levy said he called Home Medical to ask if he could avoid the rental fee and pay $500 in advance to buy the machine, a company representative said no.
Levy recalled: \"I was overcharged because I had insurance . \"
Levy refused to pay the rent.
\"I never agreed to subscribe to the rent every month,\" he wrote in a letter questioning the charges . \".
He asked for documents to prove the cost.
The company responded that he would be charged under the rules of its insurance company.
Ironically, Levy\'s legal practice focuses on defending insurance companies in personal injury cases.
So he filed a lawsuit at Home Medical accusing the company of violating the New Jersey Consumer Fraud Act.
Levy did not expect the case to be heard.
\"I know they will have to spend thousands of dollars on legal fees to defend hundreds of dollars worth of claims,\" he recalls . \".
There is no doubt that at home medical, it is agreed to allow Levy to pay $600
More than retail costs.
For the machine.
The company declined to comment on the case.
The supplier said the Levy situation was extreme, but admitted that the patient\'s rental fee often exceeded the value of the equipment.
Levy said he would be happy to comply with the terms of his plan, but that does not mean that the insurance company would charge him an unfair price.
\"If the machine is worth $500, no matter what the plan says, or the medical device company says they shouldn\'t charge the price multiple times,\" he said . \". Dr.
Douglas Kirsch, president of the American Society of Sleep Medicine, said high rents are not the only problem.
When patients do not use insurance, they can also get better deals on ventilator filters, hoses, masks and other supplies.
Cigna is one of the largest health insurance companies in the country and currently faces a category
Litigation in the United StatesS.
The Connecticut district court debated its charging practices, including those used for continuous respiratory therapy supplies.
One of the plaintiffs, Jeffrey Newfield, who lives in Connecticut, argued that Sinno directed him to order supplies through a middleman who raised the price.
Neufeld declined to comment on the matter.
But his lawyer, Robert Izard, said that Cigna signed a contract with a company called CareCentrix, which coordinated a network of suppliers for insurance companies.
Neufeld decided to contact his supplier directly to learn about his supply charges and compare them with the charges he was charged.
He found that he paid far more than the supplier said the value of the product.
Neufeld, for example, owes $25.
68 according to his Cigna plan, the price of a disposable filter is $7. 50. He owed $147.
78 The mask was purchased through his Cino program, while the supplier was paid $95.
ProPublica found that all pap supplies billed online to Neufeld are lower than the price paid by the supplier.
Users who use the ventilator for a long time say that it is known that it is cheaper to buy supplies without insurance.
The cost of Neufeld \"should be based on the lower amount charged by the actual provider, not the amount marked --
Get the bill from the middleman. \"Izard said.
Patients covered by other insurance companies may have become victims of similar price increases, he said.
Cino declined to comment.
But in the documents filed in the proceedings, it denies distorting costs or charging Neufeld too much.
The supply company did not respond to a comment.
Stephen Wogen, chief growth officer at CareCentrix, said in a statement that insurance companies may agree to pay higher prices for some services while negotiating lower prices for others to achieve
For this reason, isolating a particular price does not reflect the overall value of the company\'s services, he said.
CareCentrix field declined to comment on the charges.
Izard says Cigna and CareCentrix benefit from this backwardnessthe-
The scenario is handled by transferring the additional fee to the patient, who usually covers the marked-
Raise the price from their deductible.
Even if their insurance comes into effect, the amount the patient has to pay will be much higher.
Sleep assistance or surveillance equipment?
In the process of reporting the story, when a ProPublica colleague found out how his insurance company used his data to deal with him, concerns about continuous respiratory insurance were everywhere.
Eric Umanski, deputy editor-in-chief of ProPublica, did not have his ventilator and he woke up repeatedly all night, snorting, so painful that he was exiled to the living room
\"My marriage depends on it,\" he said . \"
In September, his doctor opened a new mask and airflow device for his machine. Advanced Oxy-
Med Services, a medical supply company approved by the insurance company, sent him a modem that he plugged into his machine and the company could change the settings remotely if needed.
But a few days later, when the mask was not yet there, Umansky called it advanced oxygen. Med.
A customer service representative told him that it surprised him: his insurance company might not pay for the mask because he did not have enough to use his machine.
\"You used only three masks on Tuesday night --and-a-
\"Half an hour,\" said the representative.
\"It took you only three hours on Monday night. \"\"Wait —
You guys use this thing to keep track of my sleep?
\"You used it to reject what my doctor said I needed?
\"Umansky\'s new modem has been transferring his personal data from his bedroom in Brooklyn to Newburgh, New Jersey. Y. -
The latter forwarded the information to his insurance company, United Healthcare.
Umanski said he was confused.
Because he needed a new mask, he didn\'t use the machine all night.
But until he proves he\'s been using the machine all night, his insurance company won\'t pay for the new mask
Although in his case he was the owner of the equipment, not the insurance company.
\"You see it as your device and serve you,\" Umansky said . \".
\"All of a sudden you realize this is the surveillance device your health insurance company uses to limit your access to health care.
\"Privacy experts say that as a large number of devices now collect patient data, including plug-in heart monitors, blood glucose meters, and Fitbits, this concern may increase, with Apple watches and other lifestyle applications.
Pam Dickson said privacy laws are lagging behind this new technology and patients may be surprised to find that their control over how or with whom data is being used is low, the executive director of the World Privacy Forum.
\"What if they found out you only slept five hours a night? \" Dixon says.
\"It\'s a big deal over time.
Will this affect your health care price?
United Medical said in a statement that it only uses CPAPs data to verify that patients use these machines.
Lawrence, owner of Advanced Oxygen
Med Services acknowledges that his company should tell Umansky that his ventilator use will be monitored for compliance, but it must comply with the rules of the insurance company in order to be paid.
As for Umansky, his doctor opened him a new ventilator airflow device, which is now two months old.
Supply has been keeping a close eye on his usage, Umansky said, but it still doesn\'t update the settings.
On Umansky, the irony is: \"I want them to spend as much time as they can to provide me with practical care, just as they monitor whether I am\" compliant \"or not.
\"This is the story of ProPublica and NPR investigating little-
Every aspect of the health insurance and health care industry.
Are you an insider in the insurance industry who has ideas about our investigation?
Please share a tip to help guide our report.