PBMs Are Also A Plague On Medical Devices

A sleep medicine doctor reports on his entirely unsatisfactory experiences with Synapse Health, UnitedHealthcare's PBM for CPAPs:

https://www.realclearhealth.com/blog/2026/01/09/insurance_middlemen_are_a_nightmare_for_my_sleep_patients_1157861.html

Insurance Middlemen Are a Nightmare for My Sleep Patients
By Jan Kriska - January 9, 2026

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 in twelve states across the South and Midwest. Since the partnership began, patients have faced unacceptable delays in getting the equipment they urgently need -- delays so severe that they amount to malpractice.

It's time for UnitedHealthcare to wake up and 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 so patients can once again breathe easy.

Synapse acts as an intermediary between health plans, medical equipment suppliers, providers, and patients, overseeing the "entire [durable medical equipment] experience -- from prescription to delivery." It promises simplified ordering, transparency and coordination of orders, efficient processing, and "unmatched" customer service.

But in my experience, it hasn't delivered anything close.

Consider the issues surrounding the continuous positive airway pressure, or CPAP, machines commonly used to help treat sleep apnea. CPAP machines keep patients' airways open and deliver oxygen while they sleep -- a life-saving necessity for many of my patients. Yet thanks to Synapse, getting one of these gold-standard machines 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. There's no way to edit medical equipment orders within the portal, so we have to manually reenter the order time when we must change something.

The portal has a chat feature, but we almost never receive responses when we use it to ask questions. When we do speak with a Synapse representative, they don't know how to use the portal, either.

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.

Before Synapse took over, my patients could get a CPAP machine in a few weeks. Now, it routinely takes more than a month -- and sometimes up to three. One desperate patient posted on Reddit -- yes, there's a Reddit thread about Synapse -- that they resorted to purchasing their medical equipment on eBay.

Previously, many of my patients would have simply called their medical equipment supplier to check on the status of their machine. 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.

Patients have reported not being able to get a representative on the phone. I haven't had much luck either. More than once, a Synapse representative has said a supervisor would get back to me. I'm still waiting.

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.

Under its agreement with UnitedHealthcare, Synapse originally covered 480,000 patients in Georgia and North Carolina. But that number recently grew. As of August 1, UnitedHealthcare expanded Synapse's reach to cover another 300,000 Medicare Advantage patients in Alabama, South Carolina, Tennessee, and Virginia. Then, on October 1, the program expanded to another 330,000 patients across Illinois, Indiana, Kentucky, Michigan, Ohio, and West Virginia.

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.