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How Insurers Are Profiting Off Patients With Sleep Apnea


Lots of people with a condition called sleep apnea use breathing machines at night. Machines help them sleep better, stop the snoring that annoys their partners and stay alert during the day. The machines and their accessories can cost several hundred dollars. A new ProPublica investigation details the lengths health insurers are going to pass those costs on to patients or avoid paying them altogether. ProPublica reporter Marshall Allen has written about this and joins us now. Welcome to the program.


CORNISH: How do these machines work?

ALLEN: Well, it's called a CPAP machine, and CPAP stands for continuous positive airway pressure. And basically, a patient wears a mask, and the mask jets air through the nose or through the mouth to keep the airway open during the night. Now, the machines also gather data on the patient's sleep habits. It will gather the number of hours that the patient slept. It will gather the number of sleep interruptions in some cases that the patient has. And patients assume that that data is just being gathered for their doctors, which it is because the doctors need to know this information so they can make sure the treatment is really effective.

But that data can also be beamed through a wireless modem to the supply company. And from there, it can be sent often to the insurance companies. And the insurance companies are gathering the data to determine whether or not the patient is using it enough so that the insurance company will pay for it.

CORNISH: And this happened to your own boss, I understand.

ALLEN: Yeah. So I was already working on this story when one of my editors, Eric Umansky, came to me across the newsroom, and he was really alarmed. And what had happened is he went to a doctor and got a new setting - a new air flow setting for his machine. And the company that supplies his device had sent him a modem to plug into the machine. And that way they could update his settings remotely, which he thought was a great convenience.

Well, he also needed a new mask, and they hadn't sent a new mask, so he called the supply company a couple days later and said, hey, I need my new mask. And they said, oh, well, by the way, you haven't been compliant with your machine. You know, last night, you only slept 2 1/2 hours. The night before, you only slept 3 1/2 hours. And that's when he realized that the machine was actually spying on him and tracking his sleep habits and sleep patterns. And the irony is he wasn't able to use the machine because he didn't have the new mask and yet they hadn't been sending the new mask because they said he wasn't using the machine. So he was caught in this kind of crazy Catch-22.

CORNISH: At the same time, is this also illegal? I mean, is there any real legal barrier to sharing this data?

ALLEN: Absolutely not. This is legal. And when patients give their consent for treatment with a CPAP machine and their doctor prescribes it, they don't necessarily realize it, but they've also given consent for the insurance company to get the information for purposes of reimbursement.

CORNISH: Marshall Allen, what are the implications for this going forward? Because sleep apnea is a pretty specific affliction, right? But there are insertable heart monitors. There are glucose meters, right? There are Fitbits. There are a lot of medical devices that are going to be sending data about. What should we be aware of going forward?

ALLEN: Well, so we did look at other devices that are common that people use, and we did find that in a lot of cases, you know, with the patient's consent, the data is being sent to the insurance companies. And what patients need to be aware of is that that data is being used to build a profile for each patient, and that profile may actually end up rating you a higher risk. And down the road, it could lead to a patient paying higher rates for their health insurance. And on the other side of it, there are all kinds of hidden ways that insurance companies are passing the cost of care on to the patients. And so even patients who are insured, in some cases, they might be better off not using their insurance than they are using it.

CORNISH: ProPublica reporter Marshall Allen - his story is on NPR's Shots blog. Thank you for speaking with us.

ALLEN: Thank you, Audie. Transcript provided by NPR, Copyright NPR.