For millions of people continuous positive airway pressure, or CPAP, machines are essential for healthy lives. Also for millions of people, the machines are secretly tracking when people are using them and are reporting back to insurance companies. Of course it's about the money; if the patient isn't using it as directed, insurers might not continue coverage for the machine and supplies.
But more than denying coverage, insurers are billing many times more than the actual costs of the machines and supplies. It's a regular racket.
“The doctors and providers are not in control of medicine anymore,” said Harry Lawrence, owner of Advanced Oxy-Med Services, a New York company that provides CPAP supplies. “It’s strictly the insurance companies. They call the shots.”
A machine that would cost in the neighborhood of $400 to $800 to buy outright usually has to be rented at fees that far surpass that cost. Supplies—the filters, tubes, etc.—bought through insurance also cost much more if bought directly, not through a plan. One insurance company, Cigna, is facing a class action lawsuit over billing practices for devices including CPAPs. One of the plaintiffs, Jeffrey Neufeld, sued after finding out how much Cigna was skimming off of his supplies. He contacted the supplier directly and found that he was paying much more than the supplier was being paid, for example he paid $25.68 for a disposable filter under his Cigna plan, for which the supplier was paid $7.50. He paid $147.78 for a face mask under his plan, and the supplier was paid $95.
And as for that reporting part, one ProPublica staffer, Deputy Managing Editor Eric Umansky found that his insurers was using his new machine to track his usage to determine whether or not they would also provide the new mask his doctor prescribed. He wasn't using his old mask as frequently, waiting on his new mask, but the insurer wasn't going to authorize the new mask without the surveillance proof that he was going to use it. “You view it as a device that is yours and is serving you,” Umansky said. “And suddenly you realize it is a surveillance device being used by your health insurance company to limit your access to health care.”
CPAPs are likely just the tip of the interactive medical device iceberg. Add in heart monitors, blood glucose meters and lifestyle apps like Fitbits and Apple watches that track and report health information to the mix, and it's a whole new world for how insurance companies can rack up their profits or deny coverage. That's just one of the many instances proving how much more work is to be done to reform our healthcare system to take these decisions out of the hands of insurance companies.