Sleep apnea is a fast-growing health complaint among Americans, and that has triggered a set of deceptive and unethical measures by US health insurers to shift the cost of using CPAP machines (the forced air machines that sleep apnea patients rely on to stay healthy) to the people who use them, with the effect that it's often much cheaper to pay cash for your machine and its consumables than it is to get them through insurance.
Insurers insist that patients rent their machines rather than purchasing them, with typical costs running to $105/month; while the machines themselves can be purchased for $500. The $105/month is below the maximum deductible for the year, and that deductible resets every year, meaning that CPAP users could end up paying out of pocket forever, spending enough money to buy dozens of machines outright.
The consumables that go with the machine are also grossly overpriced: Cigna charges insured people a $25.68 co-pay for disposable filters, while paying the supplier $7.50; the accompanying mask has a $147.78 co-pay, with the supplier receiving $95. Meanwhile, both masks and filters are available online at retail costs lower than those the supplier is paid.
This all gets worse when you factor in the remote telemetry, which covertly and nonconsensually harvests your usage data and feeds it in a constant stream to your insurer; if you fail to comply with the arbitrary minimum usage guidelines (adopted from Medicare's guidelines, which were not research based or in any other way reflective of empirical study), your insurer can cut you off and stop paying anything toward your CPAP therapy.
CPAP machines use proprietary data-formats that by design can only be decrypted by doctors in order to analyze the machine's effectiveness and tune its performance. A free/open tool called Sleepyhead, maintained by a single volunteer programmer in Australia, allows thousands of sleep apnea sufferers to undergo CPAP therapy without engaging with their doctors or insurers. Sleepytime may violate Section 1201 of the DMCA (because it bypasses an "effective means of access control" for a mix of copyrighted works like the control software, in order to access the uncopyrightable data from the machines).
It's easy to see how this price gouging could put Sleepytime and its author on a collision course with the manufacturers, especially if it lets insured people avoid the continuous surveillance that insurers rely on, leading to insurers switching away from models that are susceptible to use with Sleepytime.
This is also a perfect Medicare for All parable: as a common condition that severely threatens the health and well-being of Americans rise, the for-profit health care sector responds by controlling costs while undermining the quality of care, and adds in privacy-invading surveillance in a bid to deny care outright to large numbers of insured people.
Umansky's new modem had been beaming his personal data from his Brooklyn bedroom to the Newburgh, New York-based supply company, which, in turn, forwarded the information to his insurance company, UnitedHealthcare.
Umansky was bewildered. He hadn't been using the machine all night because he needed a new mask. But his insurance company wouldn't pay for the new mask until he proved he was using the machine all night — even though, in his case, he, not the insurance company, is the owner of the device.
"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."
You Snooze, You Lose: Insurers Make The Old Adage Literally True [Marshall Allen/Propublica]