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Thread: You Snooze, You Lose: Insurers Make The Old Adage Literally True

  1. #1

    Angry You Snooze, You Lose: Insurers Make The Old Adage Literally True

    You Snooze, You Lose: Insurers Make The Old Adage Literally True

    Millions of sleep apnea patients rely on CPAP breathing machines to get a good night’s rest. Health insurers use a variety of tactics, including surveillance, to make patients bear the costs. Experts say it’s part of the insurance industry playbook.

    by Marshall Allen Nov. 21, 5 a.m. EST

    This story was co-published with NPR.

    Last March, Tony Schmidt discovered something unsettling about the machine that helps him breathe at night. Without his knowledge, it was spying on him.

    From his bedside, the device was tracking when he was using it and sending the information not just to his doctor, but to the maker of the machine, to the medical supply company that provided it and to his health insurer.

    Schmidt, an information technology specialist from Carrollton, Texas, was shocked. “I had no idea they were sending my information across the wire.”

    Schmidt, 59, has sleep apnea, a disorder that causes worrisome breaks in his breathing at night. Like millions of people, he relies on a continuous positive airway pressure, or CPAP, machine that streams warm air into his nose while he sleeps, keeping his airway open. Without it, Schmidt would wake up hundreds of times a night; then, during the day, he’d nod off at work, sometimes while driving and even as he sat on the toilet.

    “I couldn’t keep a job,” he said. “I couldn’t stay awake.” The CPAP, he said, saved his career, maybe even his life.

    As many CPAP users discover, the life-altering device comes with caveats: Health insurance companies are often tracking whether patients use them. If they aren’t, the insurers might not cover the machines or the supplies that go with them.

    In fact, faced with the popularity of CPAPs, which can cost $400 to $800, and their need for replacement filters, face masks and hoses, health insurers have deployed a host of tactics that can make the therapy more expensive or even price it out of reach.

    Patients have been required to rent CPAPs at rates that total much more than the retail price of the devices, or they’ve discovered that the supplies would be substantially cheaper if they didn’t have insurance at all.

    Experts who study health care costs say insurers’ CPAP strategies are part of the industry’s playbook of shifting the costs of widely used therapies, devices and tests to unsuspecting patients.

    “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.”

    Insurers say their concerns are legitimate. The masks and hoses can be cumbersome and noisy, and studies show that about third of patients don’t use their CPAPs as directed.

    But the companies’ practices have spawned lawsuits and concerns by some doctors who say that policies that restrict access to the machines could have serious, or even deadly, consequences for patients with severe conditions. And privacy experts worry that data collected by insurers could be used to discriminate against patients or raise their costs.

    Schmidt’s privacy concerns began the day after he registered his new CPAP unit with ResMed, its manufacturer. He opted out of receiving any further information. But he had barely wiped the sleep out of his eyes the next morning when a peppy email arrived in his inbox. It was ResMed, praising him for completing his first night of therapy. “Congratulations! You’ve earned yourself a badge!” the email said.

    Then came this exchange with his supply company, Medigy: Schmidt had emailed the company to praise the “professional, kind, efficient and competent” technician who set up the device. A Medigy representative wrote back, thanking him, then adding that Schmidt’s machine “is doing a great job keeping your airway open.” A report detailing Schmidt’s usage was attached.

    Alarmed, Schmidt complained to Medigy and learned his data was also being shared with his insurer, Blue Cross Blue Shield. He’d known his old machine had tracked his sleep because he’d taken its removable data card to his doctor. But this new invasion of privacy felt different. Was the data encrypted to protect his privacy as it was transmitted? What else were they doing with his personal information?

    He filed complaints with the Better Business Bureau and the federal government to no avail. “My doctor is the ONLY one that has permission to have my data,” he wrote in one complaint.

    In an email, a Blue Cross Blue Shield spokesperson said that it’s standard practice for insurers to monitor sleep apnea patients and deny payment if they aren’t using the machine. And privacy experts said that sharing the data with insurance companies is allowed under federal privacy laws. A ResMed representative said once patients have given consent, it may share the data it gathers, which is encrypted, with the patients’ doctors, insurers and supply companies.

    Schmidt returned the new CPAP machine and went back to a model that allowed him to use a removable data card. His doctor can verify his compliance, he said.

    Luke Petty, the operations manager for Medigy, said a lot of CPAP users direct their ire at companies like his. The complaints online number in the thousands. But insurance companies set the prices and make the rules, he said, and suppliers follow them, so they can get paid.

    “Every year it’s a new hurdle, a new trick, a new game for the patients,” Petty said.

    Continue reading...
    My website: https://www.theherbsofthefield.com/

    "No one is useless in this world who lightens the burdens of another.” ~ Charles Dickens



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  3. #2
    Why the $#@! are these machines "prescription only" to begin with?

    You should be able to buy one off the shelf, no questions asked, and no data mining allowed.

    Seems to me you could rig up a device with off the shelf items: a dive regulator, a "hookah" hose set up and a light duty paint compressor.

  4. #3
    Quote Originally Posted by Anti Federalist View Post
    Why the $#@! are these machines "prescription only" to begin with?

    You should be able to buy one off the shelf, no questions asked, and no data mining allowed.

    Seems to me you could rig up a device with off the shelf items: a dive regulator, a "hookah" hose set up and a light duty paint compressor.

    There is a thriving black market for the used machine. But $#@! NPR. They're no doubt calling for regulation to decide who gets access to the data, and we know damned that Obamacare providers will be on the list, which means the government gets access as well since that boilerplate most of us sign at the MDs office grants them access via law enforcement.

    The solution is simple; don't let the machine hook up to the internet.
    But insurance companies set the prices and make the rules, he said, and suppliers follow them, so they can get paid.
    And just to some manufacture some outrage....don't go through insurance. Or change insurers.
    Last edited by angelatc; 11-23-2018 at 10:27 AM.
    * Enforce Border Security – America should be guarding her own borders and enforcing her own laws instead of policing the world and implementing UN mandates.

    * No Amnesty - The Obama Administration’s endorsement of so-called “Comprehensive Immigration Reform,” granting amnesty to millions of illegal immigrants, will only encourage more law-breaking.

    * Abolish the Welfare State – Taxpayers cannot continue to pay the high costs to sustain this powerful incentive for illegal immigration. As Milton Friedman famously said, you can’t have open borders and a welfare state.

    * End Birthright Citizenship – As long as illegal immigrants know their children born here will be granted U.S. citizenship, we’ll never be able to control our immigration problem.




    Reprinted from http://www.ronpaul2012.com/the-issues/immigration/ [Nov. 29, 2011]

  5. #4
    Welcome to the world of Corporate Enslavement, where the Black Market is perfectly legal, and validated with a moral code that glorifies it. This is but one of an infinite number of reasons to protect your privacy. You will be fined when they demonize normal behavior as a means of monetizing your imperfections, set by their standards. Without Privacy, everything is subject to approval. Sound familiar? Due to the subjective nature of corporations analyzing data they get their hands on about you, they now have the incentive to "find something wrong" where "wrong" is defined is the most minor of imperfections. A truly Free Market would throw insurance companies in the woods. They are financial predators who might as well just point a gun at you and say "Your money or your life". Of course when it comes time for them to pay you, its the same excuse over and over again. Youre not covered for "that", because "this". Without Privacy, they will now claim something very specific, that all that data feeds them nothing but excuses. Heart Attack? Yeah, look at all that Bacon you have in your refrigerator! And all the rest of this unhealthy food you buy, as indicated by your "Loyalty Card". So they basically offer you your own money back to you with "Club Cards" and "Memberships" making you even more trackable. But what you save at the grocery store, you pay for in increased insurance premiums. You are not saving any money, merely helping them to build the framework for your Total Enslavement.
    1776 > 1984

    The FAILURE of the United States Government to operate and maintain an
    Honest Money System , which frees the ordinary man from the clutches of the money manipulators, is the single largest contributing factor to the World's current Economic Crisis.

    The Elimination of Privacy is the Architecture of Genocide

    Belief, Money, and Violence are the three ways all people are controlled

    Quote Originally Posted by Zippyjuan View Post
    Our central bank is not privately owned.

  6. #5
    Quote Originally Posted by Anti Federalist View Post
    Why the $#@! are these machines "prescription only" to begin with?
    My dad had COPD. Never mind his BiPAP machine - he even had to have a prescription just for his oxygen by itself ...

    ETA: Also, when he was first diagnosed, the hospital wouldn't give him the O2 scrip, because his O2 sat was nominal before they released him. When I questioned her about this, the respiratory therapist told me that by regulations they were not allowed to prescribe oxygen unless his O2 sat was below a certain number, but also that the hospital wasn't allowed to sign off on his release unless his O2 sat was high enough to disqualify him for the prescription. (Yes, that's right ... the hospital staff acknowledged that my dad required oxygen, but they couldn't prescribe any ... because regulations ...)

    The upshot of this was that my dad was going to have to wait until hist O2 dropped again and then we'd have to get an appointment with our family doctor in order to get the O2 prescription. My dad was in pretty bad shape, and his CO2 levels were way too high, as well (when we got my dad to the ER, the doctor said he was surprised my dad was even alive, let alone conscious ...).

    A small local medical supply company had been contacted about my dad's needs, pending the appointment with our family doctor and the expected prescriptions (dad needed more than just oxygen; he needed the BiPAP, too) - but the guy who ran and managed the company called me up out of the blue and said he had seen my dad's numbers, and it was ridiculous and dangerous to wait even the few days until the appointment just in order to make everything "official", so he was going to set us up with the equipment my dad needed the night he was released and the dates could be fudged.

    So, anyway, yeah ... someone tell me again how we need more government regulation of and involvement in health care ... (go ahead, I dare you ...)
    Last edited by Occam's Banana; 11-24-2018 at 05:29 AM.

  7. #6
    Quote Originally Posted by DamianTV View Post
    Welcome to the world of Corporate Enslavement, where the Black Market is perfectly legal, and validated with a moral code that glorifies it. This is but one of an infinite number of reasons to protect your privacy. You will be fined when they demonize normal behavior as a means of monetizing your imperfections, set by their standards. Without Privacy, everything is subject to approval. Sound familiar? Due to the subjective nature of corporations analyzing data they get their hands on about you, they now have the incentive to "find something wrong" where "wrong" is defined is the most minor of imperfections. A truly Free Market would throw insurance companies in the woods. They are financial predators who might as well just point a gun at you and say "Your money or your life". Of course when it comes time for them to pay you, its the same excuse over and over again. Youre not covered for "that", because "this". Without Privacy, they will now claim something very specific, that all that data feeds them nothing but excuses. Heart Attack? Yeah, look at all that Bacon you have in your refrigerator! And all the rest of this unhealthy food you buy, as indicated by your "Loyalty Card". So they basically offer you your own money back to you with "Club Cards" and "Memberships" making you even more trackable. But what you save at the grocery store, you pay for in increased insurance premiums. You are not saving any money, merely helping them to build the framework for your Total Enslavement.
    Well said.

    The real tyranny is coming from the insurance companies and pharmaceutical companies.
    My website: https://www.theherbsofthefield.com/

    "No one is useless in this world who lightens the burdens of another.” ~ Charles Dickens

  8. #7
    Quote Originally Posted by donnay View Post
    Well said.

    The real tyranny is coming from the insurance companies and pharmaceutical companies.
    Its truly the exact definition of Fascism, Corporate + Govt = Fascism, and in a Fascist society, the people always lose everything, including their lives.
    1776 > 1984

    The FAILURE of the United States Government to operate and maintain an
    Honest Money System , which frees the ordinary man from the clutches of the money manipulators, is the single largest contributing factor to the World's current Economic Crisis.

    The Elimination of Privacy is the Architecture of Genocide

    Belief, Money, and Violence are the three ways all people are controlled

    Quote Originally Posted by Zippyjuan View Post
    Our central bank is not privately owned.

  9. #8
    Quote Originally Posted by DamianTV View Post
    Its truly the exact definition of Fascism, Corporate + Govt = Fascism, and in a Fascist society, the people always lose everything, including their lives.
    Exactly.
    My website: https://www.theherbsofthefield.com/

    "No one is useless in this world who lightens the burdens of another.” ~ Charles Dickens



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  11. #9
    What are the consequences of untreated sleep apnea?

  12. #10
    Quote Originally Posted by timosman View Post
    What are the consequences of untreated sleep apnea?
    High blood pressure.
    Stroke.
    Heart failure, irregular heart beats, and heart attacks.
    Diabetes.
    Headaches.
    * Enforce Border Security – America should be guarding her own borders and enforcing her own laws instead of policing the world and implementing UN mandates.

    * No Amnesty - The Obama Administration’s endorsement of so-called “Comprehensive Immigration Reform,” granting amnesty to millions of illegal immigrants, will only encourage more law-breaking.

    * Abolish the Welfare State – Taxpayers cannot continue to pay the high costs to sustain this powerful incentive for illegal immigration. As Milton Friedman famously said, you can’t have open borders and a welfare state.

    * End Birthright Citizenship – As long as illegal immigrants know their children born here will be granted U.S. citizenship, we’ll never be able to control our immigration problem.




    Reprinted from http://www.ronpaul2012.com/the-issues/immigration/ [Nov. 29, 2011]

  13. #11
    Quote Originally Posted by angelatc View Post
    High blood pressure.
    Stroke.
    Heart failure, irregular heart beats, and heart attacks.
    Diabetes.
    Headaches.
    Sounds like a bunch of made up stuff.

    My blood pressure finally went down when my doctor stopped nagging me to start taking lisinopril. It looks like fear of being nagged can raise your BP.
    Last edited by timosman; 11-24-2018 at 09:08 AM.

  14. #12
    Quote Originally Posted by timosman View Post
    What are the consequences of untreated sleep apnea?
    Brain damage.
    My website: https://www.theherbsofthefield.com/

    "No one is useless in this world who lightens the burdens of another.” ~ Charles Dickens

  15. #13
    Quote Originally Posted by donnay View Post
    Brain damage.
    This seem to be the most common side effect of using the treatment.

  16. #14
    Quote Originally Posted by timosman View Post
    This seem to be the most common side effect of using the treatment.
    Well each individual needs to be treated as such--individually. Some people are over-weight and by simply losing weight stops the apnea. I have read too much sugar in their system and by decreasing the sugar intake and refined carbs stops the apnea as well. Other foods can make sleep apnea worse. Eating late nigh--etc...

    It is incumbent upon the person to research this.
    My website: https://www.theherbsofthefield.com/

    "No one is useless in this world who lightens the burdens of another.” ~ Charles Dickens

  17. #15
    Quote Originally Posted by donnay View Post
    It is incumbent upon the person to research this.
    No $#@!, Sherlock.

  18. #16
    Quote Originally Posted by timosman View Post
    No $#@!, Sherlock.
    The problem is, most people don't bother. They trust the guys and gals with the white coats and stethoscopes to know what is best for them.
    My website: https://www.theherbsofthefield.com/

    "No one is useless in this world who lightens the burdens of another.” ~ Charles Dickens



  19. Remove this section of ads by registering.
  20. #17
    Quote Originally Posted by timosman View Post
    Sounds like a bunch of made up stuff.
    My husband does not have high blood pressure, but he has struggled with sleep apnea for longer than I've known him. And he had a stroke. I'll be sure to let him know that you think it's all bull$#@! though.
    * Enforce Border Security – America should be guarding her own borders and enforcing her own laws instead of policing the world and implementing UN mandates.

    * No Amnesty - The Obama Administration’s endorsement of so-called “Comprehensive Immigration Reform,” granting amnesty to millions of illegal immigrants, will only encourage more law-breaking.

    * Abolish the Welfare State – Taxpayers cannot continue to pay the high costs to sustain this powerful incentive for illegal immigration. As Milton Friedman famously said, you can’t have open borders and a welfare state.

    * End Birthright Citizenship – As long as illegal immigrants know their children born here will be granted U.S. citizenship, we’ll never be able to control our immigration problem.




    Reprinted from http://www.ronpaul2012.com/the-issues/immigration/ [Nov. 29, 2011]

  21. #18
    Quote Originally Posted by donnay View Post
    Well each individual needs to be treated as such--individually. Some people are over-weight and by simply losing weight stops the apnea. I have read too much sugar in their system and by decreasing the sugar intake and refined carbs stops the apnea as well. Other foods can make sleep apnea worse. Eating late nigh--etc...

    It is incumbent upon the person to research this.
    You don't have a medical degree. You did not even graduate high school, and you're absolutely not qualified to give advice on these topics. Google is not a university. Hell, research does not even mean what you think it means.
    * Enforce Border Security – America should be guarding her own borders and enforcing her own laws instead of policing the world and implementing UN mandates.

    * No Amnesty - The Obama Administration’s endorsement of so-called “Comprehensive Immigration Reform,” granting amnesty to millions of illegal immigrants, will only encourage more law-breaking.

    * Abolish the Welfare State – Taxpayers cannot continue to pay the high costs to sustain this powerful incentive for illegal immigration. As Milton Friedman famously said, you can’t have open borders and a welfare state.

    * End Birthright Citizenship – As long as illegal immigrants know their children born here will be granted U.S. citizenship, we’ll never be able to control our immigration problem.




    Reprinted from http://www.ronpaul2012.com/the-issues/immigration/ [Nov. 29, 2011]

  22. #19
    Quote Originally Posted by angelatc View Post
    You don't have a medical degree. You did not even graduate high school, and you're absolutely not qualified to give advice on these topics. Google is not a university. Hell, research does not even mean what you think it means.
    Where did I give advice? You seem to have 3rd grade reading / comprehension skills.
    My website: https://www.theherbsofthefield.com/

    "No one is useless in this world who lightens the burdens of another.” ~ Charles Dickens

  23. #20
    Quote Originally Posted by timosman View Post
    What are the consequences of untreated sleep apnea?
    In some cases, mild to moderate death.

    ---

    One of the big issues is that hospitals dont make money off of healthy people, they make money off of those who are dependent on the hospitals to stay alive. They profit for your illness, and their treatments reflect that. No conspiracy here either. Imagine you have high blood pressure, and two doctors. One doctor says take this herb, exercise, proper sleep, and cut out the sugar out of your diet. Doctor two tells you to not make any lifestyle changes at all, but give them money for this pill for the rest of your life. First doctor goes out of business because the illness was treated naturally, and there was no profit for him. Second doctor is the one thats left in business, so his word is the one that becomes medical gospel.

    They dont want you healthy, they want you sick. It benefits them. Just like invading your Privacy. They dont want you to obey, they want you to be as much of a pain in the ass as you possibly can be, within certain limitations. When you disobey, they have an excuse to Fine you, and take more money from you. This is just like School where children are not sent to become intelligent, but sent to become mentally neutered and castrated. School makes people stupid, and brainwashes children to throw away their privacy and become the consumer who is only fit for button pushing and truly being a useless eater. The same schools that teach the doctors that the only way an illness can be treated is with really expensive big dick pills. Pills that you dont understand how they work, so you send your kids to school to learn how they work, despite never learning the only thing really going in is the big giant cycle of stupidity and actions against humanity.

    ---

    Edit: Oh, and THIS:

    Japanese firms starting to encourage employees to take naps at work
    https://www.japantimes.co.jp/news/20.../#.W_lqYNtKj-g
    Last edited by DamianTV; 11-24-2018 at 05:34 PM.
    1776 > 1984

    The FAILURE of the United States Government to operate and maintain an
    Honest Money System , which frees the ordinary man from the clutches of the money manipulators, is the single largest contributing factor to the World's current Economic Crisis.

    The Elimination of Privacy is the Architecture of Genocide

    Belief, Money, and Violence are the three ways all people are controlled

    Quote Originally Posted by Zippyjuan View Post
    Our central bank is not privately owned.



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