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Sophie Lauver, MS, RD, LDN, NBC-HWC

Registered Dietitian for Aeroflow Health

Aeroflow Health recognizes the need for increased access to nutrition education and empowerment. This growing gap in care led our teams to launch Aeroflow Nutrition Services.  We believe that personalized medical nutrition therapy not only aids in preventing long-term health complications but it also is one way that we as providers can extend a helping hand and come alongside you as you manage your chronic disease and strive for a healthy lifestyle.

At Aeroflow Health, we stand by your side as your unwavering healthcare partner, providing you access to top-notch medical essentials such as continuous glucose monitors (CGMs), breast pumps, incontinence products, and CPAP supplies – all covered through insurance. We recognize the distinct health journey you are on and believe it deserves nothing but the best. Our commitment extends beyond products; it’s about elevating health outcomes and bridging care gaps to ensure you receive the quality care you deserve. Our addition of Aeroflow Nutrition Services aligns seamlessly with our mission, reinforcing our dedication to serving you comprehensively with education on your wellness journey.

Aeroflow Nutrition Services – Our Why

Aeroflow Nutrition Services takes a patient-driven, whole-person approach. We explore individual’s unique health desires and needs and guide towards sustainable goals through the impactful method of motivational interviewing. Our philosophy is rooted in curiosity, aiming to empower you with knowledge that becomes a catalyst for positive change. Not only that but we understand the anxieties that can surround the topic of food, and so our mission is to reduce this stress and replace it with enthusiasm for a lifestyle centered on healthy eating and living. At Aeroflow, we take an evidence-based approach to weight loss, meaning we view health holistically on a macro scale rather than reducing it solely to weight. By simplifying concepts like meal planning and energy balance, we’re able to give you actionable nutrition tips for day-to-day living.

Medical Nutrition Therapy –  Who Is It For & What Does It Entail? 

Medical Nutrition Therapy is an evidence-based, client-driven process for managing or treating medical conditions through nutrition. Delivered by a Registered Dietitian, Aeroflow’s nutrition therapy program is designed to help those  interested in understanding how nutrition can lead to a more sustainable and enjoyable lifestyle.

Do you feel anxiety and tension when trying to meal prep? What about feeling isolated from family and friends due to your different dietary needs? We get it. Our program has been built with all of these stressors in mind.  

Registered Dietitians would come alongside you to help you achieve the following:

  • A diet rich in whole grains, lean protein, fiber, and plant-based foods 
  • A diet low in saturated fat, sodium, and meat 
  • Mild to moderate weight loss
  • A game-plan for 150 minutes a week of moderate-intensity physical activity 
  • Stress reduction
  • Familial, professional, and community support

We understand that your health story is the product of many lifestyle and genetic factors. To ensure our Registered Dieticians are able to craft treatment courses catered to your specific needs and goals, those who take part in the program undergo a comprehensive initial evaluation that helps provide a holistic health picture. During medical nutrition sessions, you have the opportunity to explore and discuss your comprehensive health profile, covering medical and nutrition history, sleep patterns, weight fluctuations and goals, stress management, hydration, and physical activity.

Some additional program highlights include:

  • Simple and personalized lifestyle tips to help build sustainable routines that lead to a more positive overall health experience, specifically for those living with diabetes
  • Evidence-based suggestions and support from a caring, creative, and non-judgemental Registered Dietitian
  • Guides to easy-to-prepare meals and snacks that leave you feeling satisfied
  • Reduced blood glucose/A1C levels
  • Reduced risk of heart disease and stroke
  • Reduced cholesterol and blood pressure
  • Increased energy and confidence that will lead to less stress
  • Less anxiety around meal planning, grocery shopping, preparing meals, and going out to eat
  • Knowledge regarding trends and data based on your specific nutritional habits

Interested In Joining The Program?

Are you ready to take a step towards a healthier, more empowered you? We’d love to have a conversation with you. To explore Aeroflow Nutrition Services and how our personalized approach to medical nutrition therapy can support you in managing chronic diseases, building sustainable healthy habits, and achieving your unique health vision, click the “Learn More” button below to see if you qualify for this program for little or no cost through our insurance. Your journey to a healthier you starts here.
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Picture of Sophie Lauver, MS, RD, LDN, NBC-HWC

Sophie Lauver, MS, RD, LDN, NBC-HWC

Sophie Lauver is a Registered Dietitian and Board Certified Health and Wellness Coach passionate about helping people take control of their health and get excited about nutrition. Sophie has a Bachelor's degree in Communication from the University of Delaware and a Master’s degree in Dietetics from Eastern Michigan University. Sophie has worked in a wide variety of settings including hospitals, long-term care, rehabilitation, and wellness technology, and most recently, served as the director of the nation's largest diabetes prevention program. Sophie lives in Baltimore, MD with her husband, infant son, and their two dogs and two cats. When she’s not working with clients, she enjoys cooking, not doing dishes, trying new restaurants, and spending time being active outside (especially on warm and sunny days).

This content has been reviewed for accuracy by Amanda Minimi, Director of Corporate Development for Aeroflow Health. 

Health equity is a hot topic among many in the healthcare world. The term refers to the idea that everyone should have a fair and equal opportunity to achieve good health regardless of race, income or social status.  In addition, health equity addresses the social, economic and environmental factors that impact a person’s well-being. As we look at solving health equity issues, it is imperative that we take a true population health approach recognizing that one size does not fit all and leverage new age tools, technology and resources to combat equity issues. This is where telehealth comes into play.

Telehealth Health Equity – Why It Matters

Telehealth leverages digital tools and technology to provide healthcare services remotely, enabling individuals to receive medical advice, diagnoses, and treatment without physical visits to healthcare facilities. Telehealth helps reach those in the underserved communities that would otherwise lack equal access to care.

Underserved communities often include:

  • Low income Americans
  • Rural Americans
  • People of color
  • Immigrants
  • People who identify as LGBTQ
  • People with disabilities
  • Older patients
  • People with limited knowledge of the English language
  • People with limited digital literacy
  • People who are underinsured or uninsured

Those who fall into any of the above categories often face consequences such as higher mortality rates, higher medical costs, higher rates of disease and more. Key drivers of these disproportionate consequences include lack of access to transportation, lack of access to appropriately skilled providers, or time to care. 

For example,  the journey of pregnancy into postpartum care can be both exciting and overwhelming for mothers. Telehealth can serve as a support system that offers convenience and reassurance all from the comfort of home. Virtual consultations from experts on prenatal care, lactation support and mental health, addresses any concerns or complications promptly while also addressing commonly cited challenges in breastfeeding such as lack of time due to childcare responsibilities, lack of finances, or doctor did not explain/ provide support. Telehealth opens a convenient avenue for integrated and comprehensive care that may otherwise be inaccessible. Lactation consults are regularly non-covered by lactation providers and require members to pay upwards of $300 per visit and seek reimbursement directly from the plan following the visit. Where telehealth is not available, breastfeeding becomes a luxury. However, there is both high levels of interest and engagement in utilizing services like lactation consultations via telehealth. Recent data from Aeroflow Breastpumps shows that 87% of their patients who qualify for lactation services and opt-in to telehealth were between the ages of 25 and 40, proving that mothers who are given the option of telehealth visits are very likely to take advantage of the resource.

Access to telehealth provides limitless solutions to a variety of patient needs from PAP therapy set-ups to nutrition counseling for managing diabetes, the possibilities are endless. Telehealth stands as a transformative force not just for patients but also for healthcare providers. Beyond offering convenience and accessibility to patients, telehealth becomes a strategic solution to address staffing shortages and combat physician burnout. By facilitating remote services, clinicians can efficiently monitor patients’ progress, ensuring timely interventions and keeping treatment plans dynamically updated. In this symbiotic relationship, telehealth emerges as a powerful tool for optimizing healthcare delivery and enhancing the overall well-being of both patients and providers.

Barriers to Telehealth

Though telehealth proves to be an ideal alternative for healthcare for many people, there are still a variety of barriers that keep this solution from meeting all people where they are. 

Some of those barriers include:

  • Lack of coverage of telehealth benefits
  • Lack of coverage or provider types
  • Lack of listing in provider directory

According to the American Medical Association, 80% of health happens outside of the doctors office. In order to provide equitable health to everyone, healthcare and health plan professionals must adapt to meet the need.

How Health Plans Can Help

Aeroflow Health advocates for healthcare that is both easily accessible and sustainable. This commitment to accessible and convenient care is facilitated through telehealth services. While many health plans have implemented enhanced telehealth policies, promoting health equity involves continued recognition and iterations of improvement to  telehealth access which includes regular monitoring of market trends and adaptation to them. These advancements are critical to expanding access to telehealth services in underserved communities. Healthcare providers and health plans together can promote health equity and achieve healthier outcomes by placing the patient in control and reaching the patient where they want to be met. 

Health plans seeking exemplary models of successful telehealth implementation need not look further than Blue Cross Blue Shield of Oklahoma (BCBSOK) and Sunshine Health. BCBSOK, with its comprehensive telemedicine policy, allows providers under various benefit plans, including fully insured HMO and PPO plans, Blue Cross Medicare Advantage, and self-funded employer group plans, to leverage telehealth for enhanced member care. Although not explicitly stating parity with in-person services, their policy significantly expands coverage, offering flexibility within a diverse range of benefit plans. On the other hand, Sunshine Health, a part of Centene in Florida catering to Medicaid, stands out for its commitment to inclusivity. By covering telemedicine services to the same extent as in-person care, Sunshine Health ensures equitable access for all members, setting a benchmark for telehealth excellence.

Next Steps

In the face of healthcare access  gaps, telehealth emerges as a beacon of hope, seamlessly bridging critical health disparities. While telehealth may not be essential for everyone, it offers an additional and proven option to meet individuals where they are on their health journey regardless of their circumstances.  If you would like more information regarding how you can advocate and build health equity in your workplace and for your members through telehealth, please email our Strategic Partnerships team at  strategic.partnerships@aeroflowinc.com or schedule time with us here.

250,000

The number of telehealth consultations Aeroflow Health conducted in 2023.

1 day

Aeroflow Health’s average time to care via telehealth as of January 2024. This is compared to the 7 days it takes for a home visit. 

50.57%

of Aeroflow patients actively choose to participate in telehealth visits. 

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Written by Joy Payne

Joy is the Senior Content Coordinator at Aeroflow Health. With over a decade of experience in bringing brand stories to life, Joy has a profound appreciation for the power of storytelling.

As a graduate of Western Carolina University with a bachelor's degree in English: Professional Writing, Joy has actively contributed to various publications, including Grit & Virtue, AdventHealth's Experience Magazine, and Thryve Mag. Through her work, she has demonstrated a keen eye for expressing unique perspectives that resonate with audiences and elevate brand voices.

In her free time, Joy enjoys driving along the Blue Ridge Parkway, writing songs, and discovering the best coffee spots in town. Her diverse experiences and commitment to shining a light on meaningful stories underscore her expertise in the field.

References

Health equity in Telehealth. telehealth.hhs.gov. (2023, August 15). https://telehealth.hhs.gov/providers/health-equity-in-telehealth

Samuel, J. (2023, December 1). Telemedicine can be the oasis in the health care desert. Medical Economics. https://www.medicaleconomics.com/view/telemedicine-can-be-the-oasis-in-the-health-care-desert

O’Reilly, K. B. (2019, October 4). How to improve screening for Social Determinants of Health. American Medical Association. https://www.ama-assn.org/delivering-care/patient-support-advocacy/how-improve-screening-social-determinants-health#:~:text=%E2%80%9CWe%20are%20clear%20that%2080,officer%2C%20said%20in%20an%20interview. 

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Dive into our blog inspired by our webinar, “Elevating Member Experience: Empowering Health Plan Success during Open Enrollment,” where we will provide invaluable insights into optimizing your open enrollment strategy to ensure seamless operations, enhanced member experiences, and improved outcomes.  For a deeper understanding and comprehensive insights, don’t miss the chance to watch the webinar playback.

At the end of the year, do you assess member benefit engagement? If so, do you do any outreach?

Denise: Yes, we look to see if members have gone in for their annual wellness visits and will check to see if there are any gaps in care such as breast cancer or colorectal screenings. It’s a multimodal outreach campaign at this point to encourage their engagement. We engage our broker and provider partners and then we will text, email, mail, and call members to promote overall a healthy living that leads to the care they need. 

Are there any trends that you are observing in terms of open enrollment this year (2023)?

Denise: Open enrollment trends really do depend on the market. For me, in the northeast, we work a lot with broker partners and we are seeing that channel perform exceptionally well. Broker partners play a vital role during AEP as they are the trusted voices among communities. They offer members expert guidance and ongoing assistance. With the ever-present evolution of health plans in various markets, I really anticipate that these partners are going to play an increasingly significant role in future AEP’s. This type of partnership can be somewhat new but I think we need to keep evolving in these relationships to see the best overall success. Additionally, we’re seeing for the first time since COVID-19 that people are getting back to face-to face meetings, pen and paper – tangible elections. With this, it’s pertinent to meet members where they are. Offering a variety of avenues for members to elect coverage communicates intentionality that will set you apart. Whether that’s electronic, mail-in options, or in-person meetings, as health plans, we need to adapt to our members’ needs and speak to them the way they want to be spoken to. 

How do you ensure continuity of care for new members currently using DME? Are there processes or messages that are especially helpful for helping members navigate potential changes? Are they different for current vs. new members? Are there pitfalls that should be avoided?

Denise: Naturally, there are some inevitable complications that come along with open enrollment and so there will be some members that have more challenging plans to navigate depending on their situation. I’ve seen someone trying to join our plan with an oxygen need, and part of their process was having to figure out if their current DME provider would be covered under the new plan and if they were going to have to go to their physician again for another prescription order. All of these considerations can be stressful for members. As a health plan, I believe this is where proactive identification is key and provides a solution to meet people where they are. At Point32, shortly after onboarding new members, we deploy welcome calls to a subset of our members. Our goal is to gather information on this call that could pose a challenge for the member. Also, we deploy health risk assessments to our entire population because we want to identify members’ needs, including those with DME needs, and use that information to avoid any continuity of care challenges. As a health plan, providing a positive experience for members is one thing but ensuring there are no gaps in care is just as important! Many people have come to believe that health plans are like the “Big Bad Wolf” that isn’t there to help at all – we as health plans need to work to eradicate this perception and help people to understand that we want them to be healthy and that we are in their corner. 

What are the best practices in terms of informing current and future members about how their enrollment will impact cost sharing, prior authorization, and other processes used for services they are currently using?

In terms of informing current or potential members about enrollment plan shifts, health plans need to be honed into communicating the benefit information via various channels. Timely notifications, educational meetings highlighting specific changes in cost sharing and processes, and visual aids – these are all options to consider communicating benefit changes. Additionally, health plans should collaborate with healthcare providers and communicate any and all changes to plans. Once collaboration is established, it’s best practice to put a feedback system in place so that you can track progress and shared information. At Point32, our Population Health team really helps engage and communicate with members regarding any changes to their current plans so that they can make the best choice during an upcoming enrollment. This is a year round commitment we make to our members.  Strategies like these will ensure that members understand the impact on their services and hopefully reduce confusion and promote a positive enrollment experience. 

“We as health plans have a lot of information that can help us look for members that need assistance. It behooves us to be intentional about member engagement and outreach. Look at the data you have regarding your offerings and engage your members based on the facts. At the end of the day - help build plans that result in more positive health outcomes for your members.”

Denise Doucette-Ginise, MSN, RN, CCM, CHPN
To schedule time with the Aeroflow Strategic Partnership team, please schedule below.
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Picture of Michael Cantor, M.D.

Michael Cantor, M.D.

Dr. Mike Cantor is a geriatrician and attorney who has extensive experience designing and implementing value-based care, quality improvement, and care management programs for healthcare providers and health plans. He works as a fractional (part-time) Chief Medical Advisor for Aeroflow Healthcare, Uber Health, and other technology-enabled health services companies, value-based care organizations and digital health companies. Previous roles include: CMO for Bright Health Plan, an innovative health
insurer; CMO for CareCentrix, a leading outsourced home health, durable medical equipment, and post- acute care benefits manager recently acquired by Walgreens; and CMO for the New England Quality Care Alliance (NEQCA), the physician network affiliated with Tufts Medical Center, where he implemented network-wide quality improvement and care management programs for 150,000 managed care lives. He trained in internal medicine at Beth Israel Hospital in Boston and did his geriatrics fellowship at Harvard Medical School. He has degrees in law and medicine from the University of Illinois.

Picture of Denise Doucette-Ginise, MSN, RN, CCM, CHPN

Denise Doucette-Ginise, MSN, RN, CCM, CHPN

Denise is an accomplished nurse executive with a unique background combining clinical expertise, entrepreneurial leadership, and a breadth of experience across the healthcare industry.She currently serves as the Director of Medicare Member Experience for Point32Health, the parent organization of New England’s iconic managed care organizations, Tufts Health Plan and Harvard Pilgrim Healthcare. Tufts Medicare Preferred is one of very few HMO plans in the country to achieve 5-STAR from the Center for Medicare & Medicaid Services for eight years.

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This content has been reviewed for accuracy by Mike Cantor, Chief Medical Advisor at Aeroflow Health.

Dive into our blog inspired by our webinar, “Health Plan Best Practices: Leveraging Continuous Glucose Monitors (CGMs) to Improve Diabetes Care,” where we discuss how health plans can support members to ensure CGMs are maximally effective in improving diabetes care, the future of CGM management and more. For a deeper understanding and comprehensive insights, don’t miss the chance to watch the webinar playback. 

What is a continuous glucose monitor (CGM) and how does it work? How does a CGM improve the quality of care for people with diabetes, and what is the impact on costs of care and patient experience?  How is the value of a CGM different for people with Type I vs Type II diabetes?

Dr. Gabbay: Continuous glucose monitors or CGM’s are one of the largest advances in diabetes care in the last decade. CGM’s are like a movie of someone’s day instead of photos that only show a quick snapshot. With CGM’s, you are able to get continuous glucose monitoring over 24 hours, as well as be alerted when glucose levels are too high or too low. These readings are particularly useful for clinicians. Something to note is that there are 3 types of continuous glucose monitors – those that continuously monitor over 24 hours,  those that require intermittent scanning every 8 hours  with a reporting device such as an iPhone and then the most recent model on the market is one that is inserted in the abdominal region and stays in place for 6 months. CGM’s allow people to better understand how their actions impact their insulin levels and what activities or lifestyle choices they can make to promote a healthier outcome. CGM’s, while a useful data tool, in its simplest and most impactful form is a lifesaver for many. Being able to be alerted when levels are dangerous can make all the difference between life and death.  At the end of the day, all of these tools  help manage diabetes more effectively and lead to better life quality for those living with diabetes. 

Every 5 years, the American Diabetes Association publishes the Economic Costs of Diabetes report. This year, we’ve found that 1 in 4 healthcare dollars are spent on people with diabetes and their complications. Most of the cost by far comes from the complications of living with diabetes, such as, eye disease, kidney disease, nerve damage, strokes and more.  CGM’s allow people to monitor glucose levels and keep them at healthy levels, therefore,  preventing these complications that lead to higher costs. According to several studies of those with Type II diabetes, of those using a CGM, those individuals were less likely to go to the emergency room and/or be hospitalized. 

Check Out The Latest Economic Cost Of Diabetes Report

CGMs are part of optimal management of diabetes – what are the other key factors for people with diabetes to successfully manage their diabetes?  Where does diet and exercise fit in? 

Sophie: CGM’s are a tool that constantly remind people about their goals. Whether that be what they are eating, drinking or their activity, they are getting real-time data on how their lifestyle is impacting their glucose levels. I have seen that those using a CGM are much more invested in their dietary and lifestyle choices than those who are not. CGM’s should be seen as a partner in care, not a fix all. CGM’s provide data but people have to choose to take action based on the data.  In my world, diet and exercise are the two largest points of discussion in determining how to make an impact on the disease. By striving for a healthy body weight and trying to get in at least 150 minutes of moderate physical activity per week, those living with diabetes can more effectively manage the disease. When it comes to diet, I encourage patients to eat fewer foods that are highly processed and high in empty refined sugar and instead eat more whole grains, fiber, healthy fats and lean protein. Whole foods and plant-based options, in my opinion, are the gold standard. In addition to diet and activity, stress, water intake, and sleep can play a huge role in managing diabetes. I’d encourage patients to also work with their providers to determine what medications may be beneficial for their diabetes and if they are on medications, to speak with their providers before making any changes to their diet or exercise routines.

Is adherence a challenge for patients using CGMs?  What are the barriers to patients successfully using CGMs, and what can be done to address those issues? 

Sophie: Access due to lack of insurance coverage, transportation, or in general the cost being too high continues to be one of the largest barriers for patients needing CGM’s for their diabetes management. Additionally, the use of a CGM can often feel overwhelming and isolating. Historically, finger sticks have been the most common way of checking blood sugar levels, so for individuals who are now using CGM’s, even if they have family members with a history of diabetes, it can feel isolating to be the only one with a CGM. Today, providers are able to meet with patients via telehealth which has lowered some barriers to access; however, there are still those who may not have access to the internet. Our goal should be to figure out as many ways as it takes to meet these patients where they are and make it easy for them to get the care and medical supplies they need.  

Gabbay: Medications have become easier for patients to access via their insurance coverage but for CGM’s there still remains red tape that creates gaps in access that leads to patient frustration. For those that have come to rely on CGM’s as their diabetes partner, the thought of not being able to have continued access is a real fear. Changes to health plan rules and regulations such as the restrictions that come along with pharmacy benefits or durable medical equipment benefits, can often cause a process of steps and documentation with clinicians and providers that cause those gaps in care. 

What are the current recommendations about which patients qualify for CGMs? Have these recommendations changed recently, and if so, how?

Dr. Gabbay: Based on randomized controlled trials that the American Diabetes Association has supported, we found that regardless of age, if someone is on insulin, whether they have Type 1, Type 2 or gestational diabetes, everyone should be offered a continuous glucose monitor because of the benefits of use. CGM’s are safer and give better outcomes as far as blood glucose levels, especially when compared to hemoglobin A1C, which is a 3-month average of blood glucoses that can predict the major complications of diabetes.  Patients have better health outcomes with CGM’s and so they are very much the standard of care. In just the last year, our research has shown that anyone on insulin should be offered a CGM and it has ultimately led to the Centers for Medicare and Medicaid Services (CMS) expanding its coverage to include CGM coverage for anyone on insulin or on agents that can cause low blood glucoses. Additionally, we’ve been advocating with the Veterans Administration and they have changed their rules to cover CGM’s for anyone on insulin.  Recently, the conversation has shifted to how CGM’s might prove beneficial to those who are not using insulin. The research hasn’t proven strong yet but I expect this to be an ongoing focus point.

Check Out Standards of Care In Diabetes - 2023
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Picture of Michael Cantor, M.D.

Michael Cantor, M.D.

Dr. Mike Cantor is a geriatrician and attorney who has extensive experience designing and implementing value-based care, quality improvement, and care management programs for healthcare providers and health plans. He works as a fractional (part-time) Chief Medical Advisor for Aeroflow Health, Uber Health, and other technology-enabled health services companies, value-based care organizations and digital health companies. Previous roles include: CMO for Bright Health Plan, an innovative health
insurer; CMO for CareCentrix, a leading outsourced home health, durable medical equipment, and post- acute care benefits manager recently acquired by Walgreens; and CMO for the New England Quality Care Alliance (NEQCA), the physician network affiliated with Tufts Medical Center, where he implemented network-wide quality improvement and care management programs for 150,000 managed care lives. He trained in internal medicine at Beth Israel Hospital in Boston and did his geriatrics fellowship at Harvard Medical School. He has degrees in law and medicine from the University of Illinois.

Picture of Sophie Lauver, MS, RD, LDN, NBC-HWC

Sophie Lauver, MS, RD, LDN, NBC-HWC

Sophie Lauver is a Registered Dietitian and Board Certified Health and Wellness Coach passionate about helping people take control of their health and get excited about nutrition. Sophie has a Bachelor's degree in Communication from the University of Delaware and a Master’s degree in Dietetics from Eastern Michigan University. Sophie has worked in a wide variety of settings including hospitals, long-term care, rehabilitation, and wellness technology, and most recently, served as the director of the nation's largest diabetes prevention program. Sophie lives in Baltimore, MD with her husband, infant son, and their two dogs and two cats. When she’s not working with clients, she enjoys cooking, not doing dishes, trying new restaurants, and spending time being active outside (especially on warm and sunny days).

Picture of Robert Gabbay

Robert Gabbay

Robert A. Gabbay, MD, PhD, FACP, is the Chief Scientific and Medical Officer for the American Diabetes Association (ADA), the global authority on diabetes. Dr. Gabbay leads the ADA’s efforts to drive discovery within the world of diabetes research, care and prevention. Previously, Dr. Gabbay served as the Chief Medical Officer and Senior Vice President at Joslin Diabetes Center, and Associate Professor at Harvard Medical School. At Joslin, he oversaw the clinical care for over 25,000 patients, as well as the education and care programs Joslin delivers nationally and internationally. His research focused on innovative models of diabetes care to improve and to enhance diabetes outcomes and improve the lives of people with diabetes. The reach of his work has been recognized through leadership roles in national and international activities to transform diabetes care. Dr. Gabbay has served as visiting professor, keynote speaker and organizing committees for global meetings of the ADA, International Diabetes Federation, Endocrine Society, and the Diabetes Technology Society. Along with an extensive peer reviewed publication record, his views have appeared in popular press such as the New York Times, CNN, Oprah, the Washington Post and NPR.

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This content has been reviewed for accuracy by Mike Cantor, Chief Medical Advisor at Aeroflow Health.

Dive into our blog inspired by our webinar, “Health Plan Challenges and Strategies for Managing Sleep Apnea in the Post-COVID Era,” where we offer health plans valuable insights into the evolving landscape of sleep apnea diagnosis, treatment, and management. Gain actionable strategies and evidence-based recommendations to adapt your health plan’s approach to sleep apnea care, ensuring optimal outcomes for your members in the evolving healthcare paradigm. For a deeper understanding and comprehensive insights, don’t miss the chance to watch the webinar playback.

What are the greatest challenges health plans currently face in providing affordable positive airway pressure (PAP) therapy to their members with sleep apnea? 

Dr. Rabinowitz: I think the biggest challenge right now is that there are a lot of people living with undiagnosed sleep apnea. We do not have great screening tools so understanding the data side and identifying individuals with sleep apnea can be challenging. Without screening tools we’re unable to urge members to get a proper diagnosis. Another challenge would be the current state of the supply chain and being able to provide members who are diagnosed with adequate resources. 

Dr. Weiss: Because identification is such an ongoing issue, education is crucial. Health plans can help their members by providing information about common sleep apnea red flags such as waking up with a headache in the morning or gasping for air frequently through the night.  Also, educating on the populations who are most at risk, such as African Americans would be beneficial. Incentivizing those members with such symptoms to follow up with a doctor could make a huge difference!

What does the end of the COVID state of emergency mean for members in commercial, Medicaid, and Medicare plans? Are there other factors leading to changes in coverage policies?

Dr. Weiss: Patients and insurance companies should work together during this transition to adjust to “post-COVID emergency” era. Insurance plans are no longer required to cover some services, but they may choose to cover to provide better care. Home tests for obstructive sleep apnea and telemedicine services fall within this category. Patients with commercial insurance plans may have a limited number of at home tests available. Those with Medicaid and Medicare still have access to home and tele services, depending on the state. Most states kept telehealth coverage available after the COVID state of emergency.

Are there challenges with getting access to or using PAP devices due to supply chain issues? What about the use of devices that do not record usage data or cannot upload it remotely? What is the current impact of the Phillips PAP recall? 

Dr. Rabinowitz: Yes, there are still ongoing issues with members accessing PAP devices. There are 2 significant happenings to note that have only heightened this issue.  The Phillips PAP Recall took many units off the market and then created an additional problem for people needing replacement devices. Additionally, the chip shortage was especially acute for medical device manufacturers as they did not have as much clout in the global marketplace. As it relates to the data transmission issues that surfaced with thePhillips recall, compliance was a concern for the equipment that didn’t have built in telemetry. Vendors and infrastructure dealing with this issue made reporting particularly difficult for health plans. 

Dr. Weiss: Even though 2021 was a couple years ago, the Phillips recall is still affecting patients. Patients are still experiencing delays in equipment; however, I am seeing that patients are mostly experiencing fear around the potential problems their equipment might have and not so much the concern of being able to access the equipment. 

How does adherence impact access for patients and what can be done to manage this? 

Dr. Rabinowitz: From a health plan perspective, we’re always looking for the value that PAP therapy provides a patient. We’ve made great strides to help remove the barriers for patients to be diagnosed and treated for sleep apnea but we would like to know our members are benefiting from that therapy. The telemetry data from the device directly impacts how we interact with members. Based on the data, we can better understand next steps that a member might require. For example, a patient might need respiratory therapy, another sleep study or additional coaching –  we wouldn’t know these things without the data. With the additional information we can further assist. 

Home testing for sleep apnea is becoming more and more popular. How do you make sure that patients that test at home get the right testing at the right place?

Dr. Weiss: An FDA- approved home test for sleep apnea (HTSA) can be ordered by a health care provider when there is a potential diagnosis of OSA. Patients and primary care providers should attend to warning symptoms of OSA to request the test when a patient complains of snoring, gasping for air during sleep, and excessive daytime sleepiness, morning headache, dry throat, dry mouth, irritability, and “brain fog”, such as difficulty concentrating. The right time is when these symptoms become noticeable to the patient, their bed partner, a relative or someone close to them. And the right place is an accredited medical provider using an FDA-approved HTSA.  

To learn more about the sleep solutions that Aeroflow Health provides, we encourage you to schedule time with our strategic partnership team below or learn more on the Aeroflow Sleep website.
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Picture of Michael Cantor, M.D.

Michael Cantor, M.D.

Dr. Mike Cantor is a geriatrician and attorney who has extensive experience designing and implementing value-based care, quality improvement, and care management programs for healthcare providers and health plans. He works as a fractional (part-time) Chief Medical Advisor for Aeroflow Healthcare, Uber Health, and other technology-enabled health services companies, value-based care organizations and digital health companies. Previous roles include: CMO for Bright Health Plan, an innovative health
insurer; CMO for CareCentrix, a leading outsourced home health, durable medical equipment, and post- acute care benefits manager recently acquired by Walgreens; and CMO for the New England Quality Care Alliance (NEQCA), the physician network affiliated with Tufts Medical Center, where he implemented network-wide quality improvement and care management programs for 150,000 managed care lives. He trained in internal medicine at Beth Israel Hospital in Boston and did his geriatrics fellowship at Harvard Medical School. He has degrees in law and medicine from the University of Illinois.

Picture of Carleara Weiss, Ph.D., MS, RN

Carleara Weiss, Ph.D., MS, RN

Dr. Weiss is the Scientific Advisor for Aeroflow Sleep. She has over fifteen years of experience as an Adult-Geriatric Nurse Specialist, with a Master in Science of Health Care and a Ph.D. in Nursing, focusing on Behavioral Sleep Medicine and Circadian Rhythms.Originally from Brazil, Dr. Weiss earned a Bachelor's in Nursing Science, Bachelor's in Education, and completed her medical-surgical & geriatric training and Master's degree at the Federal Fluminense University, Rio de Janeiro. After eight years as Assistant Professor and Clinician overseeing adults and older adults in hospitals, nursing homes, hospices, and private practice, Dr. Weiss moved to the United States where she earned a Ph.D. and Postdoctoral training in sleep and circadian rhythms at the State University of New at Buffalo.

Picture of Phil Rabinowitz, M.D.,FACP

Phil Rabinowitz, M.D.,FACP

An Internist with a background in teaching and clinical internal medicine. Has been with Cigna since 2005. Currently a Senior Medical Director in the Clinical Performance and Quality Organization, based out of Pittsburgh, PA. Major responsibilities include: leading a team of Medical Directors, clinical oversight of National Vendors (managing HHC/DME/Sleep/PT/OT/Chiro/O&P/Cardiac Devices) as well as Strategic Partnerships; MD lead for the High Profile Escalation Team, and MD lead for out-of-network management and No Surprise Act implementation as well as many other customer experience and quality initiatives.

Table of Contents

This content has been reviewed for accuracy by Mike Cantor, Chief Medical Advisor at Aeroflow Health.

Dive into our blog inspired by our webinar, “Building for Maternal Health Equity: Addressing Barriers to Preventative Care,” where we unpack the intriguing findings from Aeroflow Breastpumps‘ recent independent study, discover key insights and standout observations that shed light on essential aspects of maternal care and explore the nuances between CLCs, IBCLCs, and doulas. For a deeper understanding and comprehensive insights, don’t miss the chance to watch the webinar playback.

 What were some of the most outstanding findings from the recent independent study supported by Aeroflow Breastpumps?

Amanda: There is a lot of data worth noting here. For example, 76% of respondents indicated access to tools, resources and support related to breastfeeding/lactation were very important or extremely important. And with that, 1 in 3 indicated it was difficult to access support. What is even more interesting to note about that number is that out of the mother’s who said they struggled finding support, 0% were white women and 13% identified as Asian, Black or African American. According to their experience, the struggle has been due to lack of time due to childcare responsibilities, lack of finances, or their doctors did not explain/provide support. When mother’s don’t receive proper education and support, they are more likely to have a difficult maternal journey. Not only did the study delve into resources and support but it also touched on mental health. Out of the mom’s surveyed, 74% indicated that breastfeeding/lactation challenges impacted their mental health. Only 4% said it did not impact them at all – this was true consistently across all subgroups. These results can be very discouraging. Our hope is that health plans recognize the need to provide equitable access to solutions like lactation consultants and doulas to meet mom’s where they are and give the education and support that every mother deserves. To view another valuable Aeroflow Breastpumps Survey, click here.

What is the difference between a CLC, IBCLC and Doula? How does their care differ?

Kiera: A doula is a trained professional who offers emotional and physical support to individuals and couples before, during, and after childbirth. Their primary focus is on providing comfort, advocacy, and guidance during labor and the postpartum period. Doulas are not medical professionals but rather experienced companions who empower birthing individuals to make informed choices about their birth experiences. While a doula’s role revolves around childbirth support and emotional well-being, a CLC specializes in helping new parents with breastfeeding. They are trained to address common breastfeeding challenges, provide education on proper latching and positioning, and offer guidance to ensure a successful breastfeeding experience. On the other hand, an ICBLC is the highest level of lactation specialist, equipped to handle more complex breastfeeding issues. They undergo extensive training and can assist with more challenging cases. In summary, a doula focuses on emotional and physical support during childbirth, while a CLC and ICBLC are experts in breastfeeding support, with the ICBLC being the most advanced in handling intricate breastfeeding challenges. Each plays a valuable role in the journey of pregnancy, birth, and postpartum care.

How can lactation consultants and doulas positively impact a mother’s mental health journey?

Leteace: Lactation consultants and doulas play a significant role in enhancing a mother’s mental well-being throughout the phases of pregnancy, childbirth, and the postpartum period. Here’s how we make a positive impact:

  • Emotional Support: We offer mothers a supportive environment to openly discuss their emotions, leaving them feeling empowered and self-assured. Our goal is to create a “safe space” where they can find emotional strength.
  • “Brain-Boob Connection” Class: Through Aeroflow Breastpumps, we conduct specialized classes that explore the profound connection between the mind and body during pregnancy and postpartum. These sessions include practical stress reduction techniques and exercises we engage in together.
  • Stress Reduction: Our mere presence and assistance can alleviate the stress and anxiety experienced by new or experienced mothers who may otherwise feel isolated. We provide reassurance and support, diminishing emotional burdens.
  • Community Building: We facilitate a weekly “Mom’s Circle” via Zoom, where mothers can come together to form a community, engaging and supporting each other at no cost.
  • Educational Guidance: We offer educational support to prepare mothers for childbirth, early breastfeeding, and the postpartum period. Our classes, such as “Birth and Breastfeeding” and “Ultimate Breastfeeding Prep,” equip mothers with the “what to expect” readiness they need.
  • Addressing Breastfeeding Challenges: As an IBCLC, we assist mothers in navigating early breastfeeding difficulties, recognizing that successful breastfeeding can reduce the risk of postpartum mood disorders. Timely addressing of these challenges is essential for maternal mental health.
  • Promoting Bonding: Our support extends to helping mothers strengthen their bonds with their babies, which is protective for their mental health.

In summary, lactation consultants and doulas are dedicated to positively impacting mothers’ mental health by offering emotional support, building community, providing education, addressing challenges, and fostering maternal-child bonding throughout the unique journey of pregnancy, childbirth, and the postpartum stages.

What are some of the major barriers/gaps that have kept the integrative care model for moms from coming to fruition? 

Kiera: Creating access to breastfeeding support is very important for new and expecting moms. The most common barriers that create a gap in care is the lack of in-network providers, telehealth options, long wait times and visibility to where they can go to receive care.  Having to plan, prepare and pay for childcare is a barrier that telehealth options could aid. Also, when health plans provide directories that show up to date in-network providers and specialists, it lessens the chance that moms will have to pay copays and deductibles. An example of how Aeroflow has been providing quick and easy access to care is the scheduling model via Lactation Link. If a mom is looking to schedule time with a lactation consultant, she can schedule a same day appointment all via an online portal. IBCLC’s  and CLC’s will always be the gold standard for breastfeeding education. When health plans provide in-network access to these types of specialists, they are choosing to meet moms where they are and partner in their motherhood journey. 

If you are passionate about addressing health disparities and ensuring comprehensive lactation and doula care for both mothers and babies to close critical HEDIS care gaps, we encourage you to schedule time with our team. You can schedule time below to learn how our program can make a significant impact in promoting maternal and infant health through lactation and doula support.
Schedule Now
Picture of Kiera Walsh, CD(DONA), CLC

Kiera Walsh, CD(DONA), CLC

Kiera Walsh is a dedicated agent of change in the realm of maternal and infant care, driven by the transformative force of education. As a DONA Certified Birth Doula, Postpartum Doula, and Certified Lactation Counselor, she passionately advocates for the vital role of education in shaping well-informed birth, postpartum, and breastfeeding experiences. 


Picture of Leteace Lee

Leteace Lee

Leteace Lee, RNC-Maternal and Newborn Care, Full Spectrum Doula, and IBCLC is a Lactation Consultant and Educator with Aeroflow Breastpumps. Leteace is a Holistic Mother-Baby Advocate, who specializes in prenatal and postpartum breastfeeding support and birth education. Currently located in MD, she offers virtual lactation consultations to women everywhere.

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Kellie Green

Kellie Green is the founder and owner of Green Living & Wellness. She is a Speech Pathologist and International Board-Certified Lactation Consultant credential. Driven by her own struggles to breastfeed, she takes pride in providing the best care possible. Her mission is to give families a great beginning, supporting them from birth and beyond to help them reach their feeding goals. She offers in office services for those local to Columbus, OH and virtually, wherever you are, via telehealth. With Aeroflow, Kellie teaches: Birth & Breastfeeding, Navigating Maternity Leave, Pumping 101, Solids, Ultimate Breastfeeding Prep.

Picture of Sarah Law

Sarah Law

Sarah-Ashley Law is a Registered Nurse and IBCLC. She started her career in newborn intensive care and worked there for over 8 years while working in the NICU she found a love of supporting families on their feeding journeys and loved learning all about breastmilk’s role in helping preterm babies grow and thrive. So in 2019 she transitioned to lactation and became an IBCLC. She has worked in postpartum, NICU, outpatient clinic, homes and virtually with Aeroflow. Sarah-Ashley teaches Ultimate Breastfeeding Prep, Pumping 101, Sleep for the Breastfed Baby, Babycare for the Breastfed Baby and Solids for the Breastfed Baby.

Picture of Amanda Minimi

Amanda Minimi

Amanda is the Director of Corporate Development at Aeroflow Healthcare, the largest provider of breastfeeding equipment and services in the nation. Amanda has led Aeroflow Healthcare's health plan partnership initiatives where there collaboration-based solutions have led to better outcomes through high patient engagement and increased instances and duration of breastfeeding. Amanda also serves as the co-chair of AAHomeCare's Breastfeeding Coalition, a team that works with states and health plans to advocate to reduce barriers in access to breastfeeding.

As a healthcare company that provides maternal mental health support services, doula care, breastfeeding support and supplies, Aeroflow Healthcare fully supports the passage of Senate Bill 455, also known as the Protecting Moms Who Serve Act. This bill directs the Department of Health and Human Services to study health issues affecting women who serve in the military, including coordinating effectively between veterans health care facilities and non-veterans health care facilities in the delivery of maternity care and other health care services.

Unique Challenges Faced by Pregnant and Postpartum Veterans

Pregnant and postpartum veterans encounter a variety of obstacles that make it difficult to access the comprehensive, high-quality healthcare they deserve. These challenges are often compounded by the unique circumstances of military life, including frequent relocations, deployments, and long periods of separation from loved ones.

According to a study by the Department of Veterans Affairs (VA), pregnant veterans are more likely to experience mental health conditions such as depression and PTSD than their civilian counterparts. Additionally, pregnant veterans who rely on VA healthcare face barriers to accessing care due to limited availability of VA maternity care providers and long wait times for appointments.

Maternal Mortality Disparities Among BIPOC Military Women

Furthermore, women who identify as Black, Indigenous, or people of color (BIPOC) are disproportionately affected by maternal mortality and severe maternal morbidity, and this disparity is even more pronounced among military women who identify as BIPOC. According to a report by the Centers for Disease and Control Prevention (CDC), Black women are two to three times as likely to experience maternal mortality as white women. Access to comprehensive maternal health services is critical to reducing these disparities and improving health outcomes for all mothers who serve in the military.

The Potential Impact of Studying Women’s Health Issues in the Military

Aeroflow Healthcare recognizes the importance of Senate Bill 455, also known as “Protect Moms Who Serve,” and the positive impact it could have on the lives of mothers who serve in the military. As a company that provides maternal health services, including mental health support, lactation support, and supplies, we understand the unique challenges that pregnant and postpartum veterans face in accessing high-quality healthcare services.

This bill directs the Department of Health and Human Services to study health issues affecting women who serve in the military, such as identifying gaps in maternity care services and coordinating between veterans and non-veterans health care facilities. By understanding and addressing these gaps and barriers, this study can improve overall health outcomes for these women.

We commend Senators Applewhite and Smith for their leadership in introducing this critical legislation. As a company that supports the unique needs of pregnant and postpartum veterans, we fully endorse this bill and urge the North Carolina General Assembly to pass this legislation to improve maternal health outcomes for women who serve in the military. Together, we can ensure that all mothers who serve in the military have access to the high-quality healthcare services they need and deserve.

Take Action to Support Veterans Maternal Health Care Today

The Protect Moms Who Serve bill has the potential to make a significant impact on the lives of pregnant and postpartum veterans. If you would like to get involved in supporting this bill and advocating for women veterans’ maternal health care, we encourage you to contact your legislators and express your support for the bill.

You can find your local legislators’ contact information through the North Carolina General Assembly’s
website. It’s important to note that legislators may receive a high volume of calls and emails, so consider using social media or attending town hall meetings to share your support for the bill.

In addition to contacting your legislators, you can also get involved with advocacy organizations that support women veterans’ health care, such as the Service Women’s Action Network (SWAN) or Disabled American Veterans (DAV). These organizations provide resources and information about advocacy efforts and how to get involved.

Together, we can work to ensure that all mothers who serve our country have access to the high-quality health care services they need and deserve.

This bill directs the Department of Health and Human Services to study health issues affecting women who serve in the military, such as identifying gaps in maternity care services and coordinating between veterans and non-veterans health care facilities. By understanding and addressing these gaps and barriers, this study can improve overall health outcomes for these women.

We commend Senators Applewhite and Smith for their leadership in introducing this critical legislation. As a company that supports the unique needs of pregnant and postpartum veterans, we fully endorse this bill and urge the North Carolina General Assembly to pass this legislation to improve maternal health outcomes for women who serve in the military. Together, we can ensure that all mothers who serve in the military have access to the high-quality healthcare services they need and deserve.

We are excited to announce Aeroflow Healthcare’s technology platform used to store, process, maintain, and transmit customer electronic protected health information (ePHI) has earned has earned HITRUST Risk-based, 2-year (r2) certification, demonstrating commitment to patient data security and privacy.

What is HITRUST?

HITRUST Risk-based certification is a globally recognized two-year validated assessment that showcases an organization’s commitment to proactive and comprehensive approaches to data protection and information risk management. The certification evaluates an organization’s information security program against various risk factors and industry-defined regulatory standards for cybersecurity. Achieving the HITRUST compliance demonstrates a robust and proactive approach to information security risk management, provides a competitive advantage, and demonstrates compliance with various regulations and laws.

Why It Matters

HITRUST has become the gold standard for ensuring the security and privacy of patient information in the healthcare industry. By undergoing the comprehensive and ongoing HITRUST certification process, healthcare organizations can provide assurance to their stakeholders that they are committed to safeguarding patient information. For patients, the HITRUST certification means that they can trust their healthcare providers to have implemented robust security standards to protect their sensitive information.

Patient Benefits

Patients are increasingly concerned about the security of their personal and medical information, particularly as healthcare providers continue to shift towards digital record-keeping and telemedicine. HITRUST certification provides assurance to patients that their sensitive information is being protected through rigorous security measures, reducing the risk of sensitive data breaches and identity theft.

With the peace of mind that comes from knowing their health information is secure, patients may be more likely to engage with their healthcare providers and share important information about their health, leading to better outcomes and improved patient satisfaction.

Payer Benefits

Covered entities have a legal and ethical obligation to protect the sensitive information of their members, and are also subject to strict regulatory requirements such as HIPAA compliance. By partnering with a HITRUST certified DME company, payers can demonstrate their commitment to meeting these obligations and maintaining the highest standards of information security.

HITRUST certification also helps to streamline the compliance process for payers, as they can be confident that their vendors are meeting the same rigorous security standards and risk management. This can save time and resources for payers and help to ensure a more consistent and effective approach to information security across their organization.

“Companies like Amazon and Apple have taught consumers how to engage digitally,” says Amanda Baethke, M.S., director of corporate development at Aeroflow Healthcare, a durable medical equipment maker based in North Carolina. “Then the COVID-19 pandemic dramatically accelerated the adoption of digital healthcare, which transformed the patient experience and left patients consuming healthcare digitally more than before.”

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Healthcare professionals often prescribe medical supplies such as oxygen equipment, PAP machines, and diabetic supplies for home use. These items are known as Durable Medical Equipment (DME) and are intended to help you manage your health from the comfort of home. DME can also be called Home Medical Equipment (HME). Insurance companies generally offer coverage for DME, and healthcare supply and equipment companies can deliver DME directly to your home.

What is Durable Medical Equipment?

Durable Medical Equipment (DME) is medical equipment or supplies a healthcare provider prescribes to you for home use. Health insurance plans, including Medicare and Medicaid, offer coverage for commonly prescribed DME. The exact DME coverage depends on your insurance. Medicaid coverage varies by state, but most Medicaid plans cover a wide range of items. Equipment often includes:

  • Diabetic supplies
  • Briefs, diapers, catheters, and other incontinence products
  • Breast pumps and other breastfeeding supplies
  • CPAP machines and supplies
  • Other equipment designed for home use
  • Other supplies designed to help you manage your health at home

Medicare coverage for DME is more limited than Medicaid coverage. As a rule, Medicare only covers equipment and supplies it considers medically necessary. This means Medicare doesn’t cover items such as incontinence or breastfeeding supplies. DME items covered by Medicare includes:

  • Test strips and diabetic supplies
  • CPAP machines and supplies
  • Medically necessary supplies designed to help manage your health at home

Commonly prescribed DME/HME

DME includes equipment and supplies you might need to recover from a hospital stay, manage a chronic health condition, or care for a disability in your home. Commonly prescribed DME includes items such as:

  • Blood sugar monitors, test strips, glucose monitors, and other diabetic supplies
  • CPAP machines and supplies
  • Walkers, canes, and other walking aids
  • Wheelchairs, scooters, and other mobility devices
  • Oxygen equipment
  • Nebulizers
  • Patient lifts
  • Orthotics
  • Hospital beds
  • Briefs, diapers, catheters, and other incontinence products
  • Breast pumps and other breastfeeding supplies

What is a DME/HME provider?

A DME or HME provider is a healthcare company that helps you secure medical equipment for your home through your insurance. DME providers contract with insurance companies to get coverage for medical supplies. Providers can then handle communications between your doctor, insurance company, and you.

The process starts when your doctor prescribes medical equipment. Once you have a prescription, you can choose a DME/HME provider that accepts your insurance plan. The DME supplier will check your eligibility and collect all the correct paperwork on your behalf. The provider will then deliver medical equipment directly to your home.

What to look for in a DME/HME provider

There are several important qualifications to look for when you select an HME/DME provider. High-quality DME providers will have:

  • Easy qualification — DME providers should make it easy to see which medical equipment your insurance covers by simply providing them with your information.
  • Curated shopping — A DME provider should allow you to filter products and only see the equipment that is covered by your insurance plan.
  • Dedicated customer service — The DME/HME provider you select should manage the process of getting medical equipment from your doctor’s prescription to your front door. Customer service reps should be on hand to take care of the paperwork, provide you with education about your DME/HME, and follow up after delivery to ensure everything is going well. You can check reviews online to see if your DME has happy customers.
  • Fast, free, and discreet shipping — DME/HME should arrive to you quickly and in discrete boxing.

Why is DME/HME important?

DME/HME can help you manage your health and improve your quality of life. DME can be ordered from home and delivered straight to you. It’s also a great way to get the necessary supplies without barriers such as childcare coverage or transportation arrangements.

How much does DME cost?

The cost of your DME will depend on your insurance coverage. Private insurance companies aren’t required to offer coverage for DME, but most plans provide

 some coverage. If you’re enrolled in a federal insurance plan such as Medicare and Medicaid, coverage will differ depending on the exact policy you have.

You might still be responsible for a copayment or coinsurance amount even when insurance provides DME coverage. For example, Medicare typically covers 80 percent of the cost of medically necessary DME. The remaining 20 percent is charged to the patient.

How do I qualify?

Your healthcare provider can help you get the DME/HME you need. They can offer recommendations for quality DME providers that might be a good fit for you. After you secure a prescription, you can contact a DME provider. Many providers have qualification forms on their websites that allow you to check your insurance coverage. If you qualify for DME coverage, the DME provider will handle your next steps. They’ll work with your insurance company and medical provider to complete all the paperwork and deliver DME to you.

Mother feeding her infant

Healthcare Savings Accounts (HSAs) and Flexible Savings Accounts (FSAs) are two distinct account types you can use to set aside tax-free money for healthcare expenses. Either option can save you money and allow you to pay for things like:

  • Medical bills
  • Copayments or coinsurance costs
  • Glasses or contact lenses
  • Vision care appointments
  • Dental care
  • First-aid supplies
  • Over-the-counter medications
  • Menstrual care
  • Smoking cessation products
  • Pregnancy tests

FSAs and HSAs have multiple similarities, and it’s easy to confuse these two popular options for medical expenses. However, differences between them are important, and understanding what makes an FSA different from an HSA can help you decide which account is best for you and any eligible medical expenses.

Comparing HSA vs. FSA

Some of the key differences between these two tax-free options include the type of insurance plan you can have with them, your employer’s relationship to the account, and how long the money can stay in your account. You can read on for more details about each type.

Health Savings Account

There are several key features of an HSA you should be aware of. These include:

  • You need to have a high-deductible health plan for eligibility — A high-deductible health plan (hdhp) is a health insurance plan with a deductible that is more than $1,400 for an individual plan or $2,800 for a family plan.
  • The money in your HSA account always rolls over — Any HSA contribution you make to an HSA account will remain in your account unless you spend it. Funds carryover over, so you don’t need to worry about using the money up by the end of the year.
  • Some HSAs are investment accounts— Some HSA accounts are investment vehicles. You can invest the funds in your HSAs to make savings grow. Other HSAs allow you to earn interest on your savings for further account growth.
  • You can only spend the money you have already saved — You can’t borrow against planned future contributions to your HSA account.
  • There are annual contribution limits — Your contribution amount can be up to $3,650 a year for an individual plan or $7,300 for a family plan. This includes any contributions your employer makes. People over 55 can contribute an additional $1,000 each plan year.
  • Your HSA isn’t tied to your employer — You can start an HSA with a health insurance plan that your employer offers during open enrollment, but your HSA won’t be connected to your job. Your HSA account is yours, and it can roll over unused funds when you leave your employment.

Flexible Savings Account

An FSA (sometimes also referred to as an Flexible Spending Account) has several unique features that aren’t found in an HSA. These include:

  • An FSA can be used like a line of credit — You can borrow against an FSA. You’ll be able to set up payroll deductions for your FSA contributions. Afterwards, money withdrawals are possible if you need funds for qualified medical expenses.
  • Your FSA is tied to your employer — An FSA is linked to your employer-offered insurance plan and your employer. You won’t be able to keep your account if you leave your job.
  • FSA rollover is often limited — In many cases, you’ll have a limited time to spend your FSA funds. The exact time frame depends on how your employer has set up the plan, but many FSAs have a window of 12 to 18 months. Any money that isn’t spent in this time will be forfeited.

Which one will benefit me the most?

The account plan for you depends on your situation, budget, and healthcare needs. Both HSAs and FSAs have benefits and drawbacks.

An HSA might be the right choice for you if:

  • You are considering changing jobs or moving every few years. HSAs are owned by you and not an employer. So if you want an account that will stay with you, consider an HSA.
  • You’re young without many healthcare expenses. You’ll need a high-deductible plan to use an HSA. These plans aren’t a great fit for people with multiple healthcare expenses, but they can work well for people who don’t have many medical expenses.
  • You want to build up medical savings. HSAs can help you save money for future healthcare expenses.

An FSA might be the right choice for you if:

  • You or members of your family see the doctor regularly. You might need a lower deductible plan if your family sees a doctor regularly. In this case, an FSA is probably a better choice.
  • You spend a lot of money on over-the-counter medications, glasses, or other healthcare items. If you buy these items frequently, an FSA could save you significant money.
  • Your employer offers dependent care FSAs. Some FSAs cover child and dependent adult care costs. If your employer offers this benefit, you’ll be able to use pre-tax dollars to pay for daycare, babysitting, home health care, and other services while you work.

Resources:

Health Savings Accounts and Other Tax-Favored Health Plans. (2020).

https://www.irs.gov/publications/p969

High Deductible Health Plan (n.d.).

https://www.healthcare.gov/glossary/high-deductible-health-plan/

Using a Flexible Spending Account. (n.d.).

https://www.healthcare.gov/have-job-based-coverage/flexible-spending-accounts/