GUEST COLUMN, Dr. Jan Kriska, Kriska Health PLLC
Nearly every day, exhausted patients walk into my office desperate for relief from sleep apnea. The condition, which causes people to stop breathing in their sleep, is surprisingly common and can be life-threatening. Thankfully, it's also manageable with the right equipment.
In fact, the hardest part of providing care and solutions for my patients suffering from sleep apnea isn't the condition itself. It's fighting the insurance middlemen who routinely delay and deny the equipment hundreds of my patients need to stay alive.
One of the worst offenders is Synapse Health, a company tapped by UnitedHealthcare to provide durable medical equipment to its Medicare Advantage beneficiaries. Since the partnership began, patients have faced equipment delays so severe that they amount to malpractice.
It's time for UnitedHealthcare to take responsibility for Synapse's failures. That means ending its partnership entirely -- or, at the very least, demanding immediate improvements to the company's operations. Synapse acts as an intermediary between health plans, medical equipment suppliers, providers, and patients. It promises simplified ordering, transparency, efficient processing, and "unmatched" customer service.
But in my experience, it hasn't delivered anything close.
Consider the issues surrounding CPAP machines used to treat sleep apnea. CPAP machines keep patients' airways open and deliver oxygen while they sleep. Yet thanks to Synapse, getting one has become a logistical nightmare.
The problems begin with Synapse's online portal, which is faulty and extraordinarily difficult to navigate. The company bombards patients and providers with requests for documentation, often for information we've already submitted, and frequently claims it never received portal submissions altogether.
Worse, the company routinely cancels orders without notice when information is missing, leaving providers and patients in the dark until equipment deliveries are long overdue. When Synapse denies a CPAP machine for one of my patients, it provides no guidance on how to appeal or obtain an alternative treatment. By not explaining how to challenge a denial, Synapse hinders patients' right to appeal under the Affordable Care Act.
Previously, many of my patients would have simply called their medical equipment supplier. But Synapse forbids suppliers from talking directly to patients. All communication must go through Synapse -- and getting in touch with someone can prove incredibly difficult.
For physicians, jumping through these hoops is maddening. For patients, it could be deadly. In a sleep study that followed more than 1,500 participants over 18 years, about one in five people who had sleep apnea but weren't controlling it with a CPAP machine died. Even over the short term, patients who don't use a CPAP experience spikes in blood sugar, heart rate, blood pressure, and stress hormones.
While patients suffer, both Synapse and UnitedHealthcare profit. Under their capitated arrangement, Synapse receives a fixed amount of money per patient per month, creating a clear incentive to delay or deny equipment. UnitedHealthcare also benefits by spending less on care -- all while shifting the blame to Synapse.
Synapse must make the necessary changes to live up to its promises. If it doesn't, UnitedHealthcare must cut ties. My patients deserve to sleep safe and sound -- not suffocate at the hands of insurance middlemen.
Dr. Jan Kriska is a board-certified physician in internal medicine, sleep medicine, and lipidology with over 30 years of clinical experience. He is the owner of Kriska Health, PLLC, operating three sleep medicine clinics in North Carolina, and a former senior partner at Blue Ridge Cardiology and Internal Medicine. This piece originally appeared in RealClearHealth.
