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You Snooze, You Lose: Insurers Make the Old Adage Literally True
- throwaway5752 8y agoIn case someone doesn't read all the way through (and you should and you should donate to propublica): "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.” Privacy experts said such concerns are likely to grow as a host of devices now gather data about patients, including insertable heart monitors and blood glucose meters, as well as Fitbits, Apple Watches and other lifestyle applications. Privacy laws have lagged behind this new technology, and patients may be surprised to learn how little control they have over how the data is used or with whom it is shared, said Pam Dixon, executive director of the World Privacy Forum."
- SOLAR_FIELDS 8y agoThe most infuriating part of all of this is that you know it was some middle project manager who got some minor bonus in the grand scheme of things (probably in the tens of thousands) for introducing some practice that is literally ruining people’s lives. It is absolutely maddening to look at this entire system and see what it has become because of above happening tens of thousands of times over.
- newsbinator 8y agoI wonder how often that middle manager looks back and regrets the move. Or how often he/she doesn't. It might be the reality that those people in society who ruin 9/10 lives are amorally oblivious, and stay that way through long, comfortable lives of their own.
- hrktb 8y agoActualy if the life of that middle manager is mildly miserable they won’t have the time to look back or regret, or really think about what they are doing for a living. And by definition they’re sandwitched in a hierarchy, that can be a hell of its own. I’d argue the health of our society could come from healthier life for these corporate workers.
- lazulicurio 8y agoI don't know if you've seen The Gervais Principle[1] before. It's a cynical but interesting way to think about some of the amoral behavior you see in corporations. It touches on how middle management gets stuck with the short end of the stick between upper-level management and lower-level employees. I'm not really sure how you could change the incentives to make things better for mid-level employees. [1] https://www.ribbonfarm.com/2009/10/07/the-gervais-principle-or-the-office-according-to-the-office/ https://www.ribbonfarm.com/2009/10/07/the-gervais-principle-...
- jononor 8y agoSelf-selection ensures that the number is relatively high, the persons who have a problem with the practice tends to quit, persons who don't have a problem stays.
- C1sc0cat 8y agoIts the same way open plan offices imposed by building services happen. The building Services manger gets a bonus or more likely an annual appraisal that saves them from a pip or rif - totally ignoring the cost in reduced efficiency and recruitment costs.
- TeMPOraL 8y agoThe principal-agent problem. You can notice it everywhere. Every time you hear the word "kickback", you know someone is paying money so that someone else can harm a group of people.
- Spooky23 8y agoThe more infuriating thing is that these cost controls exist because CPAP is a hot prescription that’s being overused. On the other side, there’s a revenue maximizination consultant pushing doctors to prescribe unnecessary equipment like inhalers and CPAP.
- chiph 8y agoI think that for the people that need it, CPAP is what lets them get a good nights rest (and possibly not die overnight). But looking at all the commercials for the machines - I get the impression that it's the new "Scooter Store", taking advantage of the federal & private money available for durable medical equipment. https://en.wikipedia.org/wiki/Scooter_Store https://en.wikipedia.org/wiki/Scooter_Store
- a_imho 8y agoI have nothing to hide! FANG already knows everything about me! /s
- jcelerier 8y agosounds like a torchwood episode
- swsieber 8y agoAnybody have recommendations for fitness/sleep trackers that respect privacy (e.g. keep data local, doesn't need the cloud)?
- applecrazy 8y agoProbably not the answer you’re looking for, but the Apple Watch keeps all data on-device until you explicitly opt-in to it being synced to iCloud.
- jmnicolas 8y agoEven though I'm an atheist, the more I see this kind of shit, the more I see wisdom in traditional religious values. Thousand years ago they (the people that "created" religions) already knew that humanity left to it's own wouldn't grow in a positive way. I'm not far from opting out completely from this inhumane society.
- setquk 8y agoRandom crazy rant there. Even as a militant atheist, this is nothing to do with religious values. It’s the ethic of reciprocity. But bastards are just bastards and that’s life. Holding people accountable for being a bastard and saying “no that’s not ok” is what we should be doing, not try substituting value systems trying to find a less cruel one.
- arethuza 8y agoSpeaking of "bastards are just bastards" - ever heard of the sociopath|clueless|losers categorisation: https://www.ribbonfarm.com/2009/10/07/the-gervais-principle-or-the-office-according-to-the-office/ https://www.ribbonfarm.com/2009/10/07/the-gervais-principle-...
- thaumasiotes 8y ago> this is nothing to do with religious values. It’s the ethic of reciprocity. This is an odd thing to say. The ethic of reciprocity is a value. What do you think religious values are?
- nimish 8y agoCatch-22 gets more real every day
- myle 8y agoUnfortunately, not as funny as the book.
- milesvp 8y agoTry rereading the catch 22 in your 30’s. I laughed at it in college, I wept at it after being an adult for a decade.
- M_V_Nostrand 8y agoIndeed, reminds me of my favourite quote from the book: “When I look up, I see people cashing in. I don't see heaven or saints or angels. I see people cashing in on every decent impulse and every human tragedy.”
- mrhappyunhappy 8y ago"Monitoring patients also helps insurance companies advise doctors about the best treatment for patients" Since when did insurance companies become doctor advisors? That's very alarming. The whole concept of unsuspecting data sharing is wrong, disturbing and should have everyone concerned.
- OliverM 8y agoHence the EU's GDPR legislation. To forestall exactly this.
- ubernostrum 8y agoA patient sees two doctors for different conditions. The doctors prescribe different medications. The patient goes to two different pharmacists to pick them up. In a victory for privacy, the patient dies from a fatal interaction of the prescribed medications. In the US there is a strong medical privacy law. And it includes an exception for providers of medical care to share treatment information with each other, for precisely this reason. Even so, every single time you see a doctor in the US, you are handed a notice saying they'll share information for permitted purposes (the triad of "TPO" -- Treatment, Payment, and Operations), and given a form to sign saying you have been made aware of this.
- Hasknewbie 8y agoEU resident here. I am reasonably sure that your doctor has access to your medical records when you hand them your smartcard, regardless of which doctor(s) previously updated said records.
- a_c 8y agoSo the patient rent a device for a price higher than retail, got personal data collected so to be denied for medical treatment and trust some device manufacturing company for transmitting data securely. It is eyeopening on so many level
- Endy 8y agoPeople wonder why I loathe insurance companies. It's really upsetting how our modern world has gotten, thanks to legalized protection rackets.
- kstrauser 8y agoI'm very pro-capitalism. I love it. I think it's great. But no matter how terrible I was raised to believe that socialized medicine would be, it simply cannot be worse than what we currently have.
- eric_h 8y agoThe thing is that some problems are not solved by an immediate profit driven market. Healthcare, education and public transportation all suffer when the required payback periods are relatively short. A good healthcare system will pay itself back by adding to the next 50 years of economic output. Good, accessible education will continue to improve the economy over generations. Good transportation increases the mobility of the entire population which allows for more competition over longer distances in a given region. By no means should we socialize everything, but we should certainly socialize the things that the free market has been failing at for decades.
- JumpCrisscross 8y ago> When his doctor prescribed a CPAP, the company that supplied his device, At Home Medical, told him he needed to rent the device for $104 a month for 15 months. The company told him the cost of the CPAP was $2,400. Levy said he wouldn’t have worried about the cost if his insurance had paid it. But Levy’s plan required him to reach a $5,000 deductible before his insurance plan paid a dime. So Levy looked online and discovered the machine actually cost about $500. Levy said he called At Home Medical to ask if he could avoid the rental fee and pay $500 up front for the machine, and a company representative said no. This looks an awful lot like fraud. Remarkably, the mark-up disclosure and best-pricing rules required to fix this could be largely copy-pasted from the securities industry.
- carlmr 8y ago>This looks an awful lot like fraud. Remarkably, the mark-up disclosure and best-pricing rules required to fix this could be largely copy-pasted from the securities industry. This is something that bothers me a lot about the American health care system. It's not that costs are exorbitant. It's patients being defrauded every step of the way. Most medical procedures, devices and pharmaceuticals would be dirt cheap if there was a) price transparency and b) competition. That not everybody is insured is one problem, but that most people need insurances just to have someone negotiating on their behalf is not sustainable. Especially when there's a quid pro quo between insurances, devicemakers and hospitals.
- k__ 8y agoI read EPAP should be a viable and cheap alternative, why aren't many people using it?
- joveian 8y agoMy understanding is that it is usually better than nothing but not nearly as effective as well adjusted CPAP or Bilevel PAP even in relatively mild apnea.
- DanielBMarkham 8y agoThe CPAP business has been a scam for many, many years. As more people use them, it's just getting worse. I think the crux of the problem is the intersection between a large population in need, the ability of the machine to keep people alive, and the machine's foray into into what once was well-marked regulatory territory, the respiratory therapist. I expect it to get worse. I need my CPAP to stay alive. I have severe, obstructive sleep apnea. So there's no option for me except "do whatever it takes to keep and maintain a CPAP" That tends to be a powerful motivator to separate people from their money. And the machines themselves, even with the cost of regulatory compliance, aren't extremely expensive. Retail they're 500-1200 bucks. From the parts involved, manufacturing costs are probably a tiny fraction of that. I've had my CPAP for years, and I was burned by the system getting it. My wife was prescribe a CPAP as well about a year ago and had an even worse experience. She was told to go down to the local CPAP shop and pick out a unit. Her insurance would cover it after her deductible. When she got there, they gave her the nicest one. Then they told her because of compliance worries, she would be paying only so much every month. If she decided she didn't want it? She could take it back in the first month or two. Makes sense, right? Then if she wanted to file with the insurance company to cover her rental, that was up to her. Flash-forward six months. The insurance company refuses to pay. She's not using it enough (even though she needs to. Long story.) So she calls up the CPAP folks. No, they will not take it back. And guess what? If you stop payments, you now owe us for the full cost of the CPAP. Not the cost you could get online. Nope. The "cost" we've put on our special price list for insurance companies. She's now in a spot where she's paid about twice the cost of the machine in "rent", plus the CPAP folks want her to pay twice the cost again -- or they're taking her to court. Try to sell it online? Great idea. They won't let you. You can't sell medical equipment online! The best part is that the manufacturer of the CPAP now bugs the hell out of her to buy all sorts of replacement parts. And why not? They're all covered by insurance! She finally gets them to shut up and leave her alone. Decides to pay off the CPAP dealer. Yet again. She goes back to the machine, more out of anger and spite than anything else. The machine refuses to work, makes you screw around with it. It's nagware, reminding her about all the supplies she needs to keep ordering. It's a fucking scam. God only knows how many billions of dollars they're screwing people out of.
- driverdan 8y ago
- patrickg_zill 8y agoJust a quick plug for cpap.com. I am a satisfied customer and have no financial interest in them. Check out their pricing for devices vs. what is listed in the article...
- NedIsakoff 8y agoWow, that's still over priced. I'm in Canada, check out https://www.monstercpap.ca/ https://www.monstercpap.ca/ -- remember that 1USD = 1.32CAD
- isostatic 8y agoI thought it was the UK that had things like 'Death Panels'.
- tialaramex 8y agoBecause healthcare requires resources and resources are inherently finite, rationing is inevitable. This means there have to be policy decisions. If you want to, you can label the policy decisions over rationing "death panels", or you can say it's just "market forces" or "God's will" or whatever turn of phrase suits your pre-existing position. Obamacare as originally designed would have such a policy setting panel, now it does not so you're at the mercy of whatever for-profit insurance companies decide. In terms of the specifics, the UK has an public body named NICE that makes decisions about how to spend limited resources in the NHS, it uses a model called Quality Adjusted Life Years, in which it tries to spend no more than a certain amount of money to buy people healthcare that will improve the amount of "quality adjusted" life they get, where e.g. "Give blind toddler normal vision" would be a big boost of quality even though it doesn't actually increase their lifespan, whereas often cancer treatments have a headline boost to lifespan but quietly admit you spend the extra time crippled by pain or other health problems the treatment does not fix or even exacerbates, so NICE would discount those extra months accordingly. But NICE does not directly mandate patient care, they're like the legislature making a sentence guideline, not the judge passing sentence on a specific criminal. NICE provides guidance, individual doctors can override that guidance, although where it's very expensive they may need clearance from somebody controlling the purse strings. For example NICE guidance might say Drug A is recommended because although Drug B has slightly better outcomes in most respects, Drug B causes incontinence in most patients and the loss of dignity from being incontinent makes for poor quality of life. Your doctor sees you're incontinent anyway for other reasons, figures you may as well have Drug B and suggests you have Drug B. They're the one signing a prescription, not NICE.
- tbihl 8y agoThe failure of Americans to recognize death panels as a feature rather than a bug are why American healthcare can't be done on a nationalized basis. As to the misunderstanding, I assume that's based either on a misstep in logic, or on moral repugnance for it.
- cyborgx7 8y agoIsn't the profit motive a great driver of I N N O V A T I O N
- jstanley 8y agoIn a free market it is, unfortunately US healthcare is too highly-regulated to be a free market, and too badly-regulated to be a working non-free market.
- Delmania 8y agoHealth INSURANCE should not be profit driven as it's a risk pool, and profit driven means they will charge high premiums and attempt to deny as much as possible. Health CARE should be driven in part by profit.
- conanbatt 8y agoA problem is that health insurance as it is organized in the us is not risk management. If you are 20 years old and healthy you get a massive premium to support a 60 year old with obesity and history of drinking. Insurance should be able to do actuarial risk and charge accordingly.
- cyborgx7 8y agoNo, sick people should not be charged more for their health insurance.
- conanbatt 8y agoHealthy young people should not be condemned to economic poverty to maintain sick people.
- fzeroracer 8y agoIt's funny then. Why am I, a healthy young person, condemned to economic poverty because my parents have poor healthcare as a result of the sham that is the US healthcare system? Tell me. Can you explain why that is OK in your narrative?
- blisterpeanuts 8y agoAn obvious question: why aren't more CPAP machines generally available for sale to end users? Amazon and Ebay mostly sell accessories. Maybe there's a business opportunity here.
- NedIsakoff 8y agoMedical device, need RX.
- wmil 8y agoI believe that's partly a government issue. They're considered a prescription medical device. So they can only be sold by specialty stores that can validate the prescription.
- ams6110 8y agoI wonder why? Are they significantly risky if used without medical supervision?
- Karunamon 8y agoThe definition of medical device is terribly non-granular, classifications notwithstanding. Something like an IV pump which directly literally kill you if it breaks or is misused is subject to the same kind of sale prohibitions as a CPAP whose absolutely worst failure case is giving you a shitty night’s sleep.
- noir-york 8y agoWhat the article described is just one device. With all the sicknesses and ailments that afflict people, the insurance companies must have a very extensive playbook... Or you know, get a national health service that treats human beings with dignity and humanity.
- jki275 8y agoYou haven't had much experience with governments if you think a national health service is going to treat people with dignity and humanity.
- jlangenauer 8y agoHave you ever experienced care with the NHS in the UK? Or Australia's public health service? Or Germany's universal health care? I have, and in all 3 cases, I've seen exceptional care from professional doctors, nurses and support staff delivered with dignity, humanity and care. Your statement is pure ideology.
- jki275 8y agoNo, I've been under government health care for the majority of my adult life in the US. I know exactly how it works, and it's abysmal.
- Delmania 8y agoNo you haven't. The ACA is not government run healthcare by a long shot. Medicare and Medicaid tend to be immensely popular.
- jki275 8y agoNot talking about ACA. The ACA has existed for what, about six years? I've been active duty military my entire adult life, over 20 years, the military healthcare system is the ideal system you're advocating for. I'm an expert in how horrible it is.
- yesimahuman 8y agoThis is going to get so much worse. There’s a whole category of health tech startups chomping at the bit to help insurance companies and billing departments instead of patients. A moment for founders to truly question whether their work will change the world for the better.
- deleted 8y ago[deleted]
- conanbatt 8y agoIts just really hard tending to patients without insurance: you would niche yourself on rich and wealthy people exclusively.
- oarsinsync 8y agoin the USA There are many countries in the world that are able to service their populations healthcare needs without involving private insurance brokers.
- conanbatt 8y agoSure, but thats what the situation is.
- howard941 8y ago> supplies would be substantially cheaper if they didn’t have insurance at all. Imaging is another area with altered pricing and lessons to be learned. I had a lumbar MRI at an imaging standalone and asked about cash pricing. The procedure costs $295 when paid in cash or $395 if paid in cash and counted against my high deductible insurance policy.
- herodotus 8y agoTracking... seems to be everywhere. Yesterday, I discovered that the head of fund raising of a group in my city gets an email whenever a donor's concert ticket is scanned at the door. Presumably this is one of the "compelling" features that the ticket-company offers its clients. (It may be Ticketmaster, but I am not sure). I have asked the group to send me their privacy policy. Maybe someone here can confirm that online ticket companies routinely offer such a feature.
- rustcharm 8y agoAbout 80% of obese people with sleep apnea would be asymptomatic if they reduced to a non-obese weight. For this subset of people, shouldn't insurers (and often the Public) encourage the patient to use the free, safe, and natural solution (eating less) before being dependent on an expensive machine? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021364/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021364/
- conanbatt 8y agoPeople have an allergic reaction to the idea that insurance for someone obese should cost more than to someone thats not obese, even though that is actuarially correct.
- perl4ever 8y agoI feel like there is an obvious reductio ad absurdam. If you are obese, yes, you can expect higher costs. If you are diagnosed with cancer, you can expect higher costs. If you are on your way to an appointment to check for cancer, you are higher risk than someone who has no cause to worry. If we take the idea of discriminating against known risk to an extreme, there would never be a payout at all, because hours, minutes, seconds, or milliseconds before a claim, there is always an indication of elevated risk. If you have full telemetry from all the cars you provide collision insurance for, you can determine that someone is an unacceptable risk moments before impact. "High frequency insurance underwriting" would only be a difference in degree from the sort of discrimination people defend, but it would make the entire industry pointless. Therefore, I believe that everybody agrees discrimination against known risks must be limited by regulation or other means to make insurance viable; we're just arguing about where to set the boundary. It is generally accepted that race, religion, and so on are prohibited forms of discrimination, but that doesn't mean there is some principle that says all other forms of discrimination are ok. Furthermore, the arguments for discriminating against the obese logically apply to protected categories, so how do you reconcile that? Apart from logic, I don't understand why anyone would want to argue in favor of discrimination against people who have a tendency to be obese, even if you don't have that particular issue. There are an unlimited number of conditions a person could have that could be similarly discriminated against.
- daveFNbuck 8y ago> insurers may agree to pay higher prices for some services, while negotiating lower prices for others, to achieve better overall value That would make sense if they were paying everything. It's a really nasty trick when they negotiate for higher prices on things they don't cover in exchange for lower prices on things they do.