Insurers cite justifications for sleep apnea monitoring

| Nov 29, 2018 | Denied Insurance Claims

The “two sides to every story” adage often takes on stark significance when bad-faith accusations swirl around insurance companies. There is often a quick call to judgment in the public’s collective mind when tales emerge of insurers’ denied coverage in a given matter. A David-versus-Goliath twist to such stories often ensures that an insurer is backtracking from the outset and forced to justify actions taken.

And that rings true even in instances where logic and empirical evidence support an insurer’s conduct. An insurance company’s claim response that is widely reviled in some cases can actually promote the public’s interest, and in a material way.

Insurers’ reported requirements focused upon policyholders’ use of breathing-assistance machines arguably serve as a case in point.

Those devices, which go by the shorthand tag of CPAP machines, help individuals with sleep apnea keep airways clear and get badly needed sleep.

The devices contain multiple component parts and can be difficult to use. And they are understandably expensive. Insurers tasked to pay for them reasonably want to know that policyholders are using them as directed.

They routinely monitor usage to ensure that. That is, CPAP devices in use are configured to send relevant information to a user’s physician, the device maker and the insurance company.

Some consumers have decried the practice, arguing that it invades their privacy and is additionally employed by insurers for other bad-faith reasons. They have followed up their expressed discontent in some cases with litigation against insurance companies.

Insurers counter that use-linked monitoring has always been standard practice, with claim denials being logical and ethical in instances where a CPAP device is not being used properly, if at all. The government itself mandates monitoring, with CPAP machines used by Medicare patients transmitting relevant information to properly interested parties.

Moreover, the insurance industry makes the telling point that monitoring can bring cost savings to the public when it reveals billings for CPAP devices that are not being used. Detailed information can lead to doctors prescribing more effective and cheaper options.

Insurers forced to defend themselves often have compelling arguments to support their employed strategies. Experienced attorneys from a proven insurance defense law firm can centrally assist them and help promote optimal outcomes as they respond to litigation or pursue financial settlements.