Insurance companies gouge on CPAP machines and consumables, use wireless modems to spy on your usage


#1

Originally published at: https://boingboing.net/2018/11/23/costs-vs-care.html


#2

If it was a ResMed device, the data went by cellular modem to ResMed directly, where it can then be downloaded by the “durable medical equipment” supplier (DME), insurer or doctor if they know the machine’s serial number. ResMed machines have no way for a consumer to permanently disable or remove the cellular modem. And ResMed uses the data for studies, giving it a massive database of millions of people.


#3

I have a beard and moustache so they gave me a mask that fit over my nose only, and told me to sleep with my mouth closed. If I can easily learn to do that, why can’t I just learn to not snore while sleeping?


#4

Fucking hell, Corporate America is a sick and twisted place. You have my sympathy.


#5

I feel like the general reaction to this story among people who’ve been using CPAPs for years has been “… duh?” As stupid as the compliance requirements are, they were explained to me quite clearly up-front at the time I got my machine, both by my doctor and by the CPAP supplies provider I got it from. (For the record, the wireless reporting is a fuck of a lot more convenient than having to make periodic appointments to drop off a data card, and the data is also used by your doctor to monitor your treatment plan and make adjustments. It’s just the insurance requirements piggybacking on the availability of that data that are terrible.)

The supplies are also a total racket, but I was at least given a machine that I paid for outright over a period of 12 months. I don’t have a rental fee.


#6

You don’t have to sleep with your mouth closed per se, rather you need to sleep without leaking the pressurized air from the PAP machine through your mouth. Some people use chin straps at night to try to help them keep their mouth closed to help keep them from leaking air through their mouth, with varying results. For most people, a nasal mask provides better treatment outcome. Under most circumstances you would have been given a nasal mask whether or not you have facial hair since having less surface area to seal they tend to seal better than oronasal masks (confusingly called “full face” masks even though they don’t cover your entire face), require less pressure for treatment and generally have more success. Ask your respiratory therapist or doctor for more info.

However, if you have a problem with “mouth breathing” while using a nasal mask you may wish to try an oronasal mask. Many people can and do get them to work with facial hair just fine, but which one may work well on your face is a very individual matter. Check the forums apneaboard.com and cpaptalk.com for threads on that exact topic. Also, if you can’t get your insurance to pay for the mask you may need, you can buy them online, and some retailers (such as cpap.com) have free “return insurance” on select items that allows you to return a mask if it doesn’t fit or work well for you.


#7

A solution is to use a discount supplier like CPAP.com that doesn’t go through insurance companies and charges greatly reduced prices. The downside is you need to pay out of pocket and then seek reimbursement through your insurance provider. I personally find it worth it. I know exactly what’s being paid out, I can control what I get and when I get it.

Of course I now have to deal directly with insurance providers and all their bullshit to get some money back. And this year they have begun really cracking down on enforcement so I may end up just saying fuck it and paying out of pocket so I don’t have to deal with it. That’s still like $1k a year in just consumables (which is still far cheaper than comparable products through a big name DME supplier) so I have to weigh if it’s worth it.

Fuck these insurance providers.


#8

Snoring happens in the back of your throat and has nothing to do with your mouth being open or closed. That said you can get a chin strap to keep your mouth closed.


#9

Unfortunately, PAP machine manufacturer ResMed (and I assume Phillips) has minimum advertised price restrictions, a currently legal form of price fixing, which prevents consumers from finding discount prices. ResMed’s flagship machine, the Airsense 10 Autoset, currently has minimum advertised price of $883, but the machine can sometimes be bought from unauthorized rogue dealers, who ignore ResMed’s price fixing, for under $600.

Strangely, there is a weird two tier pricing for PAP machines. The authorized cash price for the ResMed is $883, but the “insurance price” at some dealers is something like $2,500. Since I don’t have insurance that covers DME, I’m a bit unsure of how that works in terms of co-pays. Can an insurance company pay a discounted price and then make the insured pay a co-pay based on the inflated “insurance” price? That is, could a person paying a 40% co-pay wind up paying their insurance company $1000 for a device the insurance company actually pays $883 for?


#10

If you think it’s just CPAP Machines, You are wrong.

I’m disabled (Born with genetic defects to my heart) and in Tenn. (Dear gods no, not born here) I have “BlueCare” (BlueCross) and they had a hard-on for me to have this BP cup and charger.

After repeated “No’s” and “I’ll call you if I need somethings” I received in the mail 1 BP cup with a large USB charger. Being someone who rip’s apart anything new, I ripped open the USB Charger and guess what?

NEW USERS CAN ONLY POST 1 IMAGE
/sigh


I have 3 other photos but… Anyway…

Not only is there a sim card but it wants to connect to wifi also…
And no, Never used it.


#11

Here’s the top of the pcb:


As you can see, it’s a HUAWEI MU509 HSDPA Module
TechShip.com: Huawei MU509-C - 3G/HSDPA LGA Module - USB/UART Interface


#12

Given the first statement and my own status as an inbred pessimist, I’m just gonna say “yes, they can.” It does seem like the only realistic outcome in today’s America.


#13

Note I didn’t say discount prices, I said reduced prices.

Paying $1000 for a machine out of pocket that you now own is far different from paying $1000 toward your deductible while your insurance company is billed $5000 and can take it away if you’re not found to be in compliance. Furthermore you can optimize cost savings by keeping mask frames for, say a year (the one I use is hard plastic and won’t wear out for years) and just replacing the rubber and elastic bits as needed. Insurance companies will want you to replace the entire mask and will get billed hundreds of dollars for things that cost far less.

Since my insurance coverage sucks for CPAP coverage (and they make it as painful as possible to both understand my benefits and get reimbursed) I try to optimize as much as possible. If this means paying out of pocket to save time and headaches, so be it.

It doesn’t help that I have to pay hundreds out of pocket every time I see my sleep doctor since while he’s covered the clinic he works in isn’t which means a huge copay just for walking into the building. Avoiding this is a plus.

ETA Fuck the American healthcare system.


#14

Medicare replaces headgear on a different schedule than mask cushions, on the false assumption that headgear lasts longer. Headgear is only eligible for replacement every six months. Cushions, once a month - twice a month if they are nasal cushions. For older mask designs that schedule may have made sense but now with silicone cushions and some masks having all fabric headgear (no or minimal “frame”) the headgear can wear out much faster than the replacement schedule. (The ResMed P10 nasal pillows headgear is almost famous for losing its elasticity. And the velcro on many headgear set ups can wear out fairly fast.)

However, medicare pays separately for headgear and mask cushions, so DMEs bill separately for them for the maximum re-reimbursable amount, even though masks come complete with both.

One of the weirdest things about insurance billing in the US is that all CPAPs and APAPs are the same insurance billing code. The DME gets paid the same no matter which make and model you get. So they have a strong economic incentive to give you the one with the least features and the highest mark up.


#15

I am not on Medicare so I can only speak for the insurance plan I’m on. Just getting a list of replacement schedules from them was a weeks long exercise in frustration.

The mask I use (ResMed AirFit F20) is pretty damn robust (I could probably go for years only replacing the cushion and the straps) but I can see others being less so.


#16

Some people get a lot of use out of the F20 cushions. But the variable thickness of the seal that makes it so effective also means some of the cushion is really thin. But they still last a lot longer than the memory foam version of the cushion, AirTouch. Those can’t be washed with soap and water the way the silicone cushions are, and the foam can tear, especially at the bridge of the nose. They need to be replaced much more often.

Medicare hides theirs pretty well, too. Perhaps to keep people from maxing it out? DMEs like Apria will try to automatically send you replacements on the max schedule, whether you need them or not, and regardless of whether your insurance covers them :open_mouth:


#17

I had this with LinCare. They would send me like a years supply of things whether I wanted them or not. It got ridiculous - especially when I wanted a different mask type and I had to bring a huge box of unused stuff back to them to return. My awful experiences with LinCare were what drove me away from those big DME providers. (Sadly new rules from my insurance require me to use one of the big DMEs if I want to get reimbursed in the future.)

Have I mentioned fuck the American healthcare system?


#18

Not just breathing machines, Insulin Pumps too:


#19

No worries, cpap.com has a Black Friday sale! Here are some actual cpap.com Black Friday deals:


#20

Mine has an airplane mode.