[PLUG-TALK] You snooze, you lose: Insurers make the old adage literally true

[John Jason Jordan]

On Wed, 21 Nov 2018 08:51:35 -0800
Galen Seitz <galens at seitzassoc.com> dijo:

>I know there are some CPAP users here.  You might find this
>interesting.

That only became possible a couple years ago, and even then only if you
have a Resmed or Respironics machine. Older machines and other
brands do not have the capability. And it's not wifi or ethernet, the
connection is over a cell network. (In the US I think they use
T-Mobile.)

Recently my old machine died, with no hope of being repaired, so I had
to get a replacement. I knew about the cell connections that the new
machines could do and I was concerned. I considered getting one of the
older models - they are still available, and cheaper than the new
types - but I finally settled on a Respironics that can do cell
connections. I did so when I discovered that I could completely disable
its connection just by pulling out its 'modem.' (That's what they call
the cell device.) You can also pull the 'modem' out of Resmed's
competing machine, but then the machine won't work until you reset its
OS, which is not easy to do. 

The new connection capability was added by manufacturers at the request
of providers. Bear in mind that for Resmed and Respironics I am merely
a PITA, and not their customer. The providers are the ones who decide
which machine to supply to their patients, and providers want to be
able to view their patients' data, and also make changes to the
settings on the patients' machines, without needing patients to bring
their machines to the office. This saves time, which saves money. Bear
in mind that most people with sleep apnea are older patients, who
frequently have little technical knowledge. The machines also have an
SD card, and the patients could just bring that instead of the whole
machine, but when discussing these things with a sleep specialist at
Kaiser she pointed out that it is not uncommon for a patient to not
know how to remove the card, so they show up for their appointment
without it. It is easier for them to just tell the patient to bring the
machine. And being able to access the machine over the cell network
makes it all even easier.

Before getting my new machine (which I got from Kaiser) I expressed
concern about the cell connectivity. The sleep specialist I was talking
to said that they had 4,000 sleep patients and only three specialists,
so no way were they going to access machines to snoop on patients.
Still, I have seen a couple posts online from patients outraged that
their provider (not Kaiser) made changes to their machine without their
knowledge or permission. I think it is rare, however.

Having said all that, I suspect the incidence of snooping might be more
common during the first 30 days because of insurance requirements.
The machines are a pain, and there is a high percentage of patients who
are non-compliant. Insurance rules state that they will pay for the
machine only if the patient uses it for at least four hours a night for
70% of the nights during the first month. After that the insurance
needs no additional proof of compliance. 

I might add that Kaiser made money on the deal because I have Medicare.
Medicare reimburses Kaiser for 80% of the retail cost (retail cost =
$1,500), and they got a 20% co-pay from me, so they collected the whole
$1,500. But they bought the machine for about half that - I can buy one
online myself for about $800, and with their purchasing power I'm sure
they got an even better deal.