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They denied some orthotics for me. I appealed and just pasted the section of my plan that says they were covered. They eventually paid but how was it even denied in the first place?
Regardless of how much you are paid, if you have to actively work to survive, you are working class and are not of the ownership class. Full stop. End of story.
Im going to do a big guess that if he could delegate his property and business and just live of that profit, then hes ownership class. Some people just dont like being idle, but there is a big difference between working because you WANT and working because you HAVE to.
If your father worked out of love for his job or pure greed then sure he's owning class. But if he had to work to continue to have a good life the he's working class.
Or even simpler. Could he take a 6-8 week vacation just for fun any time of year without it impacting his financials? Could he go into a coma and live off assets for the rest of his life? If not then he's working class
Owning class is Musk, Gates, Bezos. They could be be in a coma for decades and they'd not even notice.
Class actions are not individual lawsuits, which require no automatic additional step from a judge to proceed.
Class actions, on the other hand, generally require certification of the proposed class by a judge. That means they need to meet the criteria of a class action to proceed as a class action, otherwise people must sue individually.
There are 4 variables duye a class under federal civil procedure to be met -- which would likely be the jurisdiction of a class action against UH -- but states can have their own verification rules. That said, states generally ape the feds' class rules.
You are correct and this is essentially the biggest reason why US healthcare is so broken and expensive.
However, this is not a fault of the insurance companies. They have to deny some claims. Denying some care is a normal part of every healthcare system on the planet - but in UHC countries the denials are more structured and handled more efficiently and cleaner (top down + doctor-level).
We have foisted the role of gatekeeper onto the insurance companies. They're terrible at this role, but it's one of the key roles they have to play. To fix this, we need to move the gatekeeper of care. This change alone would make a major difference in US healthcare costs (though not as good as an actual UHC system).
I mean there's a big difference between healthcare being "denied" (not really a word that makes sense in the context of universal healthcare) because it's not medically appropriate and healthcare being denied to maximise profits.
I mean in the UK you just get the treatment that the doctor says is medically correct. It's not really being "denied treatment" if you (for some reason) want something random that's not relevant to your issues. But you won't be denied doctor-recommended treatment for monetary reasons or whatever.
This idea of "claims" as a whole just doesn't exist in countries w/ universal healthcare.
> healthcare being "denied" (not really a word that makes sense in the context of universal healthcare)
It is. Look up how QALY decisions are made, for example in the UK. Someone has to decide how to allocate the scarce resources. Demand for healthcare is nearly inelastic and unlimited. Someone has to decide where we draw the line.
> because it's not medically appropriate and healthcare being denied to maximise profits.
Once again you're over simplying this. Profits in the healthcare industry are relatively small. The core problem is a problem of scarce resource allocation and unlimited demand. Someone must decide how the resource gets allocated.
> I mean in the UK you just get the treatment that the doctor says is medically correct. It's not really being "denied treatment" if you (for some reason
Yes, you are never told of alternative options, diagnoses, or treatments. You are diagnosed and told the step treatment to follow. You're not told about the experimental treatments that might help youb- even when they might actually be what you need. Because the board above the doctor has already decided how to allocate the scarce resources and the doctor is simply informing you of how it works.
There's a ton more options. There's a ton more tests and potential solutions, step treatments that you could have skipped but were required to do. You have to hope the board gets it right (and they usually do). But it's still a scarce resource allocation system, it's just handled with a 5 minute doctor conversation instead of 87 calls and letters to the insurance company.
Don't get me wrong it's a much better system. We need it in the US. But I want people to be honest about what the problem is.
> I mean in the UK you just get the treatment that the doctor says is medically correct.
Only if it’s been approved by the NHS.
> But you won't be denied doctor-recommended treatment for monetary reasons or whatever.
Yeah you would be. The NHS still has a finite budget. For example it won’t spend 30 million pounds on end of life care on a dying 96 year old grandma to give her another week.
There are some value-for-money evaluations done by NICE (not the NHS), but only for things with unproven or poor efficacy.
Expensive treatments that work are still approved.
Yes there are infrastructural limitations, but that's completely different to standard and needed/proven medical procedures being denied to maximise profits.
This has happened to me a few times. Based on how much I make per hour, it isn’t worth going in circles with insurance for 4 hours on my day off to get them to cover a few hundred bucks. It’s infuriating honestly.
I don’t want to share my private health information with a stranger. It feels simpler to just pay the money - happens maybe once or twice a year, so it isn’t often. It’d be nice if insurance just covered what they say they will cover without a fight, but we continue to allow the insurance companies to run relatively unchecked and unpenalized for things like that.
I think they're suggesting you employ a trusted assistant for $10/hr to do this and other things for you daily... so basically just find an idealistic youngster and rope them into work that won't translate into experience for any meaningful field and pay them poverty wages.
no, i wouldnt recommend you do it to a reddit stranger either, but theres probably a decent middle ground that exists, someone you can personally trust, whether an institution or a person. Seems like it would be worthwhile if you're really getting fucked by insurance like that.
It’s a nightmare trying to get insurance to pay for a CPAP. They send you to the worst DME place in your area who doesn’t care about your brand preference and won’t even just give you the same model that you already had (the motors and gaskets all break and eventually the internal computer won’t let you keep using it even if you repair it) or the newer version of the same model. Then, they charge full price and you don’t find out if your insurance is going to cover it even if you’ve already hit your deductible. So you might end up paying $1200 for a machine that reasonably should be $200.
If you’ve got $500, you can just skip the whole mess and send your prescription to an online store and hopefully get credit for it on your deductible (by submitting a form) and take 3 days to get a new one instead of 2 months. Then you can tell the DME place what machine and mask you use and they’ll set up your supply order and make sure your insurance adds it onto your deductible, though you will still pay out of pocket for that.
And this is on a PPO plan. I’m sure it’s worse for HDHP
I simply don’t have the time or energy for it. If they deny me a $200 charge, that’s less than two hours of work for me to eat the cost or it’ll be an entire afternoon on the phone going in circles and being stuck on hold for a *chance* of insurance picking up the tab. I fought that stuff years ago when I was in my early 20s making $35k/yr, but it just isn’t worth it to me anymore.
It’s the same modus like your parking tickets. They’re banking on people to just give up and pay. Since alot of people really have no choice but to appeal, atleast they were able to weed out some people and that they got a statistic that looks good to shareholders. Capitalism shouldn’t affect basic human rights but we are in the end game here, Billionaires are investing to keep people where they are. The same idiots who get screwed are the ones voting for these Billionaire puppets.
They do the same thing in hospitals where people are looking for services (therapy, nursing) and placement (rehab) after an admission. They run hospital staffs ragged because they deny a safe discharge plan (determined by actual clinicians) for people and effectively keep the bed occupied with a person that doesn’t need to be in the hospital anymore, thus preventing another person that actually needs a hospital bed from being admitted. United also takes a very long time to review the case (on purpose) to delay the discharge as long as possible in the hope that the patient/hospital staff gets fed up and leaves anyways. They’re a parasite on the healthcare system but they’re far from the only one. Humana comes to mind as well. Coincidentally, people with government funded healthcare (Medicare) don’t run into this issue nearly as often.
Anybody who thinks they know how health insurance works needs to watch The Rainmaker. Insurance companies are all Ponzi schemes where they collect as much premiums as possible and pay out absolutely the bare minimum was possible. Their profit margins only come from minimizing overhead/operating budget and minimizing payouts. They are financially incentivized to deny reimbursement at every turn. They are only checked by government regulation and lawsuits, and they will always do the calculus of whether the macroscopic profits of their practice justify whatever fine or lawsuit they have to settle.
this actually creates jobs. if something is denied then presumably healthy people need to work to approve it. it is a job creation program which is good for society.
A friend of mine who runs a small healthcare company had to sue them for unpaid bills. They claimed they couldn’t pay because they got hit by ransomware and were using it as an excuse. 2.5 years of unpaid patient insurance. My friend had the choice of rejecting patients or eating the costs.
As soon as they filed lawsuit miraculously the money appeared.
I'm surprised you can even legally sue them considering the credentialing/contracts they have in place. In my state there isn't a statute of limitations for an insurance company to claw back claims they paid in the past. It's completely insane and soon there won't be any clinics left that take insurance. It'll all be cash pay or out of network only and that will have a disproportionate effect on people of lower socioeconomic status and those with serious medical needs. We always hear whining about death panels with a single payer system, but we already have those death panels in place now.
This would actually be a better option. It would force doctors to compete on price. As of now, there is no transparency on pricing and numbers are just made up. Runny nose? Here’s a z-pack. That’ll be $4,000.
Automated denial system. The lawsuit claimed that they had like a 90% error rate. 9 out of every 10 decisions being reversed eventually.
Offloads the burden onto the consumer/patient and medical offices, leaving them to navigate archaic communication systems that are somehow on par with the government or worse. Mind you we are talking about a company with AI systems. Makes you wonder if they want patients to get the healthcare they already pay for.
Even if people do get the healthcare on appeal a small delay means the insurance company got to keep that money earning interest for an extra bit of time instead of paying out immediately.
There needs to be a penalty for each denied claim that was wrongly denied.
Thats why if an ai denies coverage, and then later it turns out they should have been granted coverage the company that used ai to initially deny should pay a penalty for that ai denial, in addition to any other payments or compensation.
No company should be allowed to issue blanket denial of coverage, via ai or otherwise, for things that are covered.
Because humans don't read claims, it's all done automatically by software that's designed to deny as many claims a possible to maximize quarterly profits
Yup. Got caught in the clearinghouse once. Where no human from the provider office, or the insurance company knew where or why my claim was getting denied. Clerical error put my sex as male on the claim, didn’t match my subscriber info. Kept getting denied then and there with no one at Cigna even seeing it/having record of receiving it. Took a year to solve the mystery of the $700 strep test.
Because they can, there is no punishment for them wrongfully denying claims and making you fight them to pay, so they are making bank on people who are too sick, dying or dead to fight them, so they deny everything untill it would cost them more to keep fighting than paying.
Put laws on the book that makes them have to pay out 10x undiscounted cost in damages to patients if they wrongfully denies the initial claim, and 1000x if their wrongful denial directly cause provable harm or worsened prognosis for the treatment. And suddenly this practice magically evaporates...
People didn't cheer when the CEO got murdered for nothing, this company and the entire industry is a blight.
> Put laws on the book that makes them have to pay out 10x undiscounted cost in damages to patients if they wrongfully denies the initial claim, and 1000x if their wrongful denial directly cause provable harm or worsened prognosis for the treatment. And suddenly this practice magically evaporates...
Sorry, this would not work. It would massively increase costs for everyone. Insurance company profit margins are not very big and these costs would just be passed on.
You have the right idea but this is way, way too punitive. Denials of care requests are normal in every country including UHC countries. They just handle it much more efficiently and with strong cost-aware, fair policies. The U.S. forces insurers to do the "cost aware" part and to be the gatekeeper of care, but they are not good gatekeepers. To have a better system, we need to move the gatekeeper of care. If we do implement consequences for denying care, the consequences need to be reasonable because denials are a normal occurrence in healthcare.
It is not supposed to be punishment, it is supposed to be deterrence to enforce and reward competence. If they do their job right instead of rubber stamping denials, they have nothing to worry about. The only times you get denied care in UHC countries is if it is not an approved treatment, only really happens with cutting edge treatments or new drugs or if your doctor can't come up with a medical justification for the treatment, like healthy people wanting ozempic to stay skinny..
If you deter something that needs to happen as a fundamental part of the system, the system will break. Healthcare denials are a natural part of all healthcare systems because healthcare is allocating scarce resources. The difference is, UHC systems do it efficiently and sometimes almost invisibly. And it works better the way they do it. But that doesn't mean we can ignore the actual cause of our problem.
There is no need for insurance to wrongfully deny coverage, this is what would trigger this. I am talking about insurance companies who willfully breach their contracts with customers as a willed business strategy, because it is more profittable than honoring it.
> There is no need for insurance to wrongfully deny coverage,
In the real world there is no magic button that decides "wrongfully". Medical situations are highly complex with a ton of nuance and other factors that have to be considered per patient. It is not possible to create a formulaic set of rules that can handle every edge case correctly.
> I am talking about insurance companies who willfully breach their contracts with customers as a willed business strategy, because it is more profittable than honoring it.
You're imagining that this is obvious and clear cut. And right now maybe, for some specific situations, it might be. All this law would do is slightly push back a small amount of the egregious violations back into the grey area. Insurers would get better at satisfying your law by denying more of the grey area stuff and avoiding crossing the line. But the core problems of our system remain, and we'll keep bleeding money and having worse outcomes.
> In the real world there is no magic button that decides "wrongfully". Medical situations are highly complex with a ton of nuance and other factors that have to be considered per patient. It is not possible to create a formulaic set of rules that can handle every edge case correctly.
Anything is better than the current system where non-medical insurance staff makes life and death medical decisions that get people killed because it will make the shareholders a few dollar richer.
There are alot of reasons. I worked in insurance and the person submitting the claim could have made a mistake (they are often understaffed and underqualified), their claims system could have been misconfigured which can kick out the claim, your patient data or the provider data could have had problems, etc.
I think people don't realize just how many claims these companies receive, how many errors these claims often have, and how many of them are auto-adjudicated which means that no human being ever actually looked at the claim.
They also ofcourse don't really want to pay your claim either.
They likely deny most claims that aren't common in effort to whether people down and hope they don't keep resubmitting the claim. Wouldn't surprise me in the slightest.
The CEO who was murdered by someone who isnt Luigi Mangione had approved an AI-based system to accept or deny claims quicker, shortly before his death.
The system denied about 90% of claims, but he accepted its implementation in that state anyway.
Most people dont fight it. Insurance companies are a scam and should be illegal. They are probably some of the first that will be targeted as the proletariat goes after the bourgeoisie in the next few years here.
The fact that the billers who billed the orthotics didn't do this is pathetic. But good on you. Most consumers would just pay. -context I was a medical biller for 10 years.
There’s no accountability for wrongful denials unless someone sues. If there was process oversight, governance, and penalties to hold insurance providers accountable, then you wouldn’t be seeing as many denials. The issue would be much higher premiums and unhealthy people without health insurance.
Because insurance companies realised that they could make more profit by not paying out.
It isn't just healthcare insurance,.it's pet insurance, car insurance, house insurance etc Insurers are refusing to pay or underpaying in the knowledge that lots of people won't push back. Healthcare insurance is particularly cruel because it's sick, dying and bereaved people who would have to fight back.
National industry average for denial is 16-20%. The 33% denial rate is absolutely abnormal. Record profit should not come at the expense of people’s lives and health with those unethical practices.
What’s the difference between a Health Care Insurance Provider and a Hit Man? They both end peoples lives prematurely for profit. Differences? First, volume. One makes a shit ton more money and is entirely legal and pays great dividends to investors.
So from what I can tell the average economist is... well.... they think they're a social scientist who uses math... but that's an insult to those who've studied math (like myself) and those who studied social sciences (like most of my family lol). Buuuuut, as the autistic one of the bunch, I believe the correct generalization here is just the concept of "excess deaths" which is, admittedly, not anywhere as direct a term, but being able to point to "decision X instead of decision Y resulted in approximately N excess deaths" is... a much more concrete way to point out that someone made a choice and that choice means a lot of people aren't alive (which to anyone sane is obviously a case of murder!)
I think this is more about the distributed responsibility and our numbness to it. There is rarely a single reason why something happens. A combination of several tiny decisions made by unrelated people may have disproportionately terrifying consequences when combined. And it is neither necessary nor sufficient to figure out what the singular decision X was that lead to excess deaths directly, in order to figure out that the entire situation is fucked up and needs a major reform.
That analytical approach is designed specifically to minimize blame and chalk the phenomenon up to statistics, thus perpetuating the cycle that enables it
You'd like to see the rate of denials of treatments that have been medically advised by a doctor in the UK?
Zero. It's zero. Because, and this is a crazy idea I know, if a doctor says you medically require a treatment you should receive the treatment. There are no middle men.
Health insurers are required to spend 85% of premiums on healthcare or they are required by law to issue rebate checks to their members or their employers.
Yeah, out of insurance hospitals and pharmaceutical companies, Insurance actually makes by far the least profit because they're mandated to spend most of it on healthcare.
claim denials aren't the best way. it ignores efforts they do to prevent claims to begin with. medical loss ratios are a better metric, but even then, a lot of insurers also employ doctors and game mlr. you have to adjust for their internal medical cost inflation.
I work in an unrelated industry, but it has the same business model.
When you advertise using the big tech ad networks, your ads will get loads of fake clicks. The average number of fake clicks by ad network is as follows:
Meta (Facebook): 5%
Meta (Instagram): 68%
Meta (Audience): 58%
Google (Search): 14%
Google (Display): 22%
Google (YouTube): 4%
LinkedIn (Platform): 19%
LinkedIn (Audience): 24%
Microsoft (Search): 14%
Microsoft (Audience): 16%
TikTok (Platform): 27%
TikTok (Audience): 27%
So, if you advertise on Instagram, you have a greater than 50% chance of the click being from a bot.
The ad networks are supposed to detect these fake clicks, and refund them to the advertisers. But they don't. Why? Because every bot click and every denied refund is pure profit. The same business model as the insurance companies.
This is why Luigi is considered a hero among so many Americans. Dramatically improved claim approval in the immediate aftermath, to the point UNH was sued for approving claims
I had a teacher in high school who had worked at United before having a crisis of conscience. He talked about it in one of our classes related to the Ford decision and the reality of the system we have created. He did not explicitly but very pointedly used framing to compare it to the Holocaust - the mechanized killing where every person could have the psychological distance to not feel they were killers, and where everyone kind of shrugs and goes about their day because it hasn't yet been their loved ones the machine is eating.
I like to point out something similar in politics - everyone who voted for Trump in 2024 voted for the decision to close USAID... which is going to cause at least a holocaust worth of deaths while also fucking over American farmers and putting a bunch out of business. Like, you can say you just voted for the President, but there sure are a lot of dead poor people in the world 2 years later because of that and that number is increasing at a faster rate now than just a year ago...
I believe they are referring Dodge Brothers vs Ford motor company, which was the case that cemented that investors interests were the primary concern for the executives at a company, not long term company or worker well being.
Well, kinda. There's a reason anarchists stopped doing it which seemed like a pretty damn good reaosn at the time (on account of accidentally starting fucking World War I....)
Between how they found him and how they treated the evidence after they found him, there is plausible deniability Right there whether or not he is or isn't guilty. the guy was fully masked up His eyebrows don't match.
>Thompson's murder resulted in a massive strategy change: that it wasn't willing to pursue its widespread claims-denying "as a result of heightened scrutiny...as well as open hostility."
At least according to this lawsuit, more americans had their claims approved as a direct result of their ceo's death. So this isn't one ceo being replaced by another and business as usual. This is meaningful change that directly impacted the lives of thousands of americans who otherwise wouldve had their claims denied to boost the share prices.
I think most people would like to not shoot people to affect change. Not saying to shoot people myself, either. But you can't be serious. People have been pushing for medicare for all for decades. We haven't gotten it. It's looking like we're just as far away from it now as we were 20 years ago. We are the only developed country in the world to not have universal healthcare. People have been trying through the legal channels, and it's gotten them nowhere.
... where do you think almost all worker rights come from? see, when a mommy anarchist and a daddy liberal team up to fight the battle of blair mountain... or team up to write a book about the meat industry... or threaten the lives of racist southern whites on one hand while peacefully marching on the other...
It's not the way most people want to make changes, given the literal fact that most people aren't doing it, but it is also wrong to act as if it is not an effective way to do so. c.f. most changes in human history?
That said, I am a proponent of nonviolent resistance instead of random assassinations. I absolutely do not trust 'the masses' to commit a bunch of killings to any positive effect for society. I mean, The Singing Revolution worked. It's just hard to get cynical people on reddit to be anything other than pointlessly reactionary.
Im not condoning violence, but its pretty clear our government has failed its basic duty to protect the citizens in the US. And when the government fails, well this year we are celebrating the 250th anniversary of shooting people we disagree with for freedom.
You said it would be business as usual when they replace the ceo with the next. I was merely countering that claim.
>Mr. Thompson’s death also forced a public reckoning over prior authorization. In June, nearly 50 insurers, including UnitedHealthcare, Aetna, Cigna and Humana, signed a voluntary pledge to streamline prior authorization processes, reduce the number of procedures requiring authorization and ensure all clinical denials are reviewed by medical professionals.
You're gonna support the death machine in this topic?
Brian Thompson served as CEO of UnitedHealthcare from April 2021 until December 2024, a tenure of roughly three years and eight months.
During his time leading the largest health insurer in the United States, his key decisions and operational impacts included:
Massive Profit Growth: Under his leadership, UnitedHealthcare’s annual profits surged from 12 billion to 16 billion. in 2023, while the parent company saw revenues top $281 billion annually.
Denials: He led a firm that increasingly relied on automated claim denials and algorithms to limit coverage for procedures, therapy expenses, and post-acute care. These stringent cost-cutting policies led to intense scrutiny, including government investigations and class-action lawsuits.
Oh, he was so innocent killing all those people. Indirectly, of course, because it's fine when they're just a number on a page. Just like you.
To be clear, I'm not saying anyone should k!ll you, H@rm you or anybody else. No one should commit violence against anybody else, in a perfect world.
An essay? Man, when was the last time you wrote a fucking essay? if you can't see moving to not cover things that they are supposed to cover and a massive profit increase and can't see how those two things might be intertwined, You might be willfully ignorant because you're on the payroll.
I am not advocating vigilante justice, but Take a look at history and see how things changed in the past. that'll lead you to maybe an idea of how things will change in the future. Because peaceful protests don't work in a system like the American one.
I have a dream. The grassy knoll.
I think you're okay with thousands of Americans dying every year by preventable illnesses, and the line is somewhere before that, and you're just not caring because it doesn't affect you.
I am not advocating vigilante justice. But here's why it is acceptable. Good one.
They aren't dying because of that ceo, they're dying because the politicians don't do anything about it. Keep voting trump, it will get better in the third term.
Whoever actually killed Brian Thompson killed a middle-aged mass murderer. Just because you end someone's life with a pen instead of a knife doesn't make you more innocent.
Luigi, on the other hand, is completely innocent and was with me and twenty other people having a pizza party.
In doing so, he saved the lives of many more. Stopping a mass murderer from inflicting death to innocents is something you won't see me crying about, especially if it leads to other killers stopping in their tracks as well.
The oligarchs won't pat you on the head and give you a slice of bread until you cradle the balls and massage the tip with your tonsils, so keep trying.
I think it could be better said that regardless of his innocence or guilt, Luigi has become a beacon for the American people at large due to his arrest for what has become a poignant and important incident that directly led to more people getting care approved.
Healthcare providers are required to pay out 85% of collected premiums. It's the law. Anybody telling you numbers about claim approvals or denials or record profits has a dishonest agenda.
Because the law ever stopped any of these unscrupulous insurance companies from doing anything to boost their profits... Especially with this administration that treats the constitution as if it was toilet paper. If they ever do get caught, after a decade long legal battle with their army of lawyers defending them, they'll just pay a small fine and that's just the cost of doing business. Meanwhile those profits just keep rising.
If you have evidence of securities and accounting fraud at a major healthcare provider is taking place, then get the fuck off of reddit and do something.
Hey dipshit, you do know that such evidence and fraud needs to come internal whistle-blowers or via investigation? Which has happened multiple times.
How about testimonial yields from their customers that they're being unfairly denied? Because there's plenty of those too.
You think you're smart but you're actually simpleton as fuck.
During 2007 your dumbass would probably be saying:
"If you have evidence of securities and accounting fraud at a major financial institutions is taking place, then get the fuck off of facebook and do something."
You see how low brow of a statement that is? Never go around pretending to be mr gottcha. You are the last person thats gonna gottcha someone with the dumbest statements.
Full disclosure: I am employed by United Healthcare
You are correct that the ML ratio is a law enacted by the ACA. 85% of premiums must go to medical claims. Some stick closer to that, and UNH has set goals for that metric.
However, there isn't a law regulating whom profits from the payment of those claims. UNH directly owns vast healthcare businesses, PBMs, Optum etc. This allows them to reap financial benefit by paying those claims out to themselves when the insured use medical providers and servicers under UNHs direct ownership.
This is a way they can benefit from their notorious rate of claim denials. Denying more claims but simultaneously paying fatter claims to their own healthcare businesses keeps them legal with the 85% rule while juicing the profit margins of their business and thus themselves. Paying those fatter claims to themselves actually benefits them in 2 ways, because the 85% rule also incentivizes maximizing both premium collected and payments distributed to increase total profits in the same way as a cost-plus contract. And when the patients they insure are afraid of claim denials and being stuck with an enormous bill, they are even more likely to choose healthcare providers directly owned and suggested to them by UNH
I keep getting this commercial that I hear. It’s for United Healthcare and part of the commercial is a supposed United employee saying “everyone matters”.
They are asserting that a third of all claims are fraudulent, whether negligent or willful.
A THIRD?!? With this volume, they are asserting that a third of the country are willing to commit fraud.
There is no rational explanation for this except that UnitedHealthcare themselves are the ones committing fraud in their polices where they state what they cover.
Well, you see, it makes more sense when you realize that for profit health insurance companies view having to pay for healthcare as a preventable loss in income. Labeling as much as you can ‘fraud’ just makes it easier to make money.
Even the 16% denial by other insurance companies is unacceptable. This person that essentially spent half their life learning to provide care recommended x treatment and the insurance company knows better based off of their vague third party understanding?
Many doctors commit insurance fraud doing medically unnecessary procedures and tests for profit. Unfortunately there are no good guys in this system; doctors, hospitals, pharmaceutical companies, and insurance companies are all fighting to extract as much as they can from the consumer….I mean patient.
lol the people caught are the tip of the iceberg. How many people don’t report their cash tips as income? How many are prosecuted for it? You can’t be naive enough to think all the convictions are the only cases of fraud
Why are you replying to me? My point was doctors commit fraud I made no mention of the percentage claims that are fraudulent because that data isn’t out there and obviously you can only count the ones caught.
I was responding to the preceding comment and then you chimed in. My point to him was fraud exists so you can’t have a 100% approval rate. Have no idea what the optimal rate is but it ain’t 66% nor is it 100%
It doesnt mean a third of the country is willing to commit fraud. Some people willing to commit fraud can submit many fraudulent claims. Its entirely plausible. I dont know though whether the claims they reject are fradulent
That would require that they are constantly flooded with millions of fraudulent claims for procedures who are somehow adding 30% to the total volume of healthcare claims in the country. That's absurd.
It's not just fraudulent claims, it's claims that are not in line with the policy, usually for services that aren't covered.
For example, I broke my wrist in 2020 and my insurance stopped covering OT after 30 visits because that was the policy limit for that injury. They were able to hide behind medical necessity because their metrics show 30 visits is sufficient for any injury.
Now the whole thing was bullshit, and I lost function in that wrist, I don't have full ROM in that wrist now and I'll never be able to regain it because the recovery window is closed, but that was their out.
A common one today is physicians attempting to prescribe Ozempic for weight loss. A lot of times the doctor will tell the patient they don't think it will be covered, but they can try and see if it will and it usually gets denied unless it's associated with a diabetes diagnosis.
I love how people keep saying this as something that absolves everything that the insurance industry is all obviously doing. that there's no way that it could ever be circumvented.
You have a convicted felon pardoning people for massive drug offenses and, in all likelihood, a pedophilia ring that he himself ran, in the coming months. You think that health insurance companies can't get around this little issue?
Hey, PFAS is allowed to be discharged into your water again soon. Sewage in your drinking water? A-okay.
As we all know, healthcare insurance companies are good corporate citizens who love following the law and want to help people. They absolutely pay out their required 85% because they know that there would be harsh consequences for not doing so.
Consulting is such a fucking scam. No shit spending less of your money will increase fucking profits you fucking dweeb.
And what happens after an insurance company does reject 40% of claims and post record profits? They have to post record profits again next year and the advice will be to add a few percent to that number again.
The genuine ceiling to this is finding the point at which the denial percentage causes a cultural shift in Americans that make them believe it is simply better to go without insurance.
Claim denial rate isn’t even what you really care about. Is it the case that they deny claims to seek profit? There’s federal mandates on spending >85% of premiums on health care, they can’t just pocket the money. People just want a scapegoat, the system is unhealthy but it’s a combination of manufactured scarcity, bad pricing incentives, and grifting govt money that got us here, not just greedy insurance companies
The 85% is technically true but hides the fact that they have vertical integration within pharmacies and doctors. For example, the same company owns your doctor, insurance, pharmacy, etc. So you go to the doctor, your procedure would have normally cost $1000. Insurance pays $900, so it looks like 90% MLR. In reality that $900 is paying their other company, which they own and get to keep the profits of. The cost of care going up increases their premiums paid, but they are really paying themselves. The whole thing is a bad faith loophole.
Agreed on bad faith loop, but I’m saying bad incentives aren’t only within the insurance companies. In other words, I think the problem is more complicated than “evil insurance company” where “get mad at insurance company” will lead to “regulation against insurance companies” and that will lead to lower prices for people. I think the quality of care Americans get is really bad for what they pay for, and we need to intervene on scarcity at the supply level to make meaningful improvements
healthcare and large systems like it are deeply complex and have multi-faceted problems which will also require multi-faceted solutions. Discourse around them tends to be "okay, but X is also a problem, and Y solution doesn't solve for X", but also losing sight into the fact that X doesn't solve for Y. Yes - there are scarcity problems that should be addressed. Yes - the MLR loophole is ridiculous and there should be some trust-busting of big firms being able to get around it. There are a lot of different regulations that should likely happen, investments into education, investments into better QOL for healthcare professionals to attract more talent, etc. All will need to happen. I'm glad it's not my job to solve it
> There’s federal mandates on spending >85% of premiums on health care, they can’t just pocket the money
They kinda can though, there's basically no punishment or consequences for their crimes. Insurance companies are out here automatically denying claims from doctors asking for routine procedures to deal with known issues for patients. Every healthcare worker in the country will tell you that getting insurance to pay for healthcare is one of the largest barriers to healthcare around.
You're ignoring that they are at times the one that these claims get paid out to. So they can deny you if you're going to use some other service that doesn't include their sister companies. And then when you go to their sister company, they can artificially inflate how much they're going to charge you because they're paying themselves.
if there are hands and feet above the industry standard, that is indicative of a problem. How do you not see that that's not something that should be looked into and And is it an obvious litmus of how horrible they are?
Keep sucking that insurance cock, right? They'll one day give you that explosive ending that you love so much.
We can have more than one problem, and being angrier and more insulting about it won’t lead to better outcomes. Americans have bad healthcare outcomes for what they pay for, the fact that there are multiple reasons underlying this beyond mustache twirling executives doesn’t mean I’m even a fan of them. You’re just angry and unable to reason about the system more than meme-able quips
They can absolutely pocket the money if they own healthcare subsidiaries that they preferentially pay claims to over external healthcare facilities. Which they do.
My Mom had side effects from radiation treatment post surgery and treatment for cancer. UnitedHealthcare was the only insurance company that wouldn’t cover her medication. That company is the worst.
A bit of context. Most denials are just, “we aren’t going to pay this based upon a few codes on a claim firm without looking at medical records.” Once records are submitted, most claims are paid. Believe it or not, too many healthcare providers cheat.
That’s not to say insurers are blameless in a mess Congress hasn’t adequately addressed in 60 years.
I've had stuff kicked back 3 times because the insurance company didn't bother to check that the one requirement, X-rays, was already done. Multiple doctors have said that it's very common that they have to just resubmit multiple times without changing anything.
The average person isn't aware the extent of fraud that is done by doctors across the country every day. Doctors, understandably, have a good reputation, but some of them are extremely greedy people who exploit the flaws in the healthcare system.
A common way doctors commit fraud is by performing unnecessary procedures or by intentionally submitting incorrect procedure codes that are more expensive. The patient is never going to know that wrongdoing was done, because they trust their doctor and they wouldn't be able to notice well hidden fraud like that. It's really the insurance companies that have to try to police this, because who else will?
I work in this industry as a data analyst and have personally done reviews of this type of fraud and it was eye opening to say the least... That said, this fraud is not a major reason why healthcare costs are so high. Fraud is just silently a major issue that all types of insurers have to deal with and healthcare insurance is no exception.
> It's really the insurance companies that have to try to police this, because who else will?
Medical boards and independent regulatory agencies, ideally. Evaluating the necessity of procedures should be done by an independent third party of medical professionals qualified to evaluate the cases. The insurance company has a financial incentive to label things as fraud and punish doctors for seeking more expensive procedures. You don't hire a random guy to check if your house is up to code, you hire a licensed professional. Healthcare fraud investigation should be carried out by licensed medical professionals who can actually evaluate the facts of a case.
Explain this to me:
What is the point of visiting a “network” provider, if the insurance provider isn’t confident that the doctor wouldn’t commit fraud?
What are they fucking vetting then?
The 33% denial rate is specifically for ACA Marketplace Plans. Their denial rate across all plans in 10% (including the 33% for ACA Marketplace plans.)
I went on their website and found a nurse practitioner at a CVS MinuteClinic near me. Went to see her had a physical nothing crazy some refills some bloodwork took 20 minutes. A month later i got a $700 bill in the mail because it was "out of network" despite me finding it on their website. I called CVS and asked if they would bill me the cash price and they said they can't because they have a contract with UnitedHealthCare despite me being out of network. I appealed the claim and they took 3 months to review it but eventually denied it. By that time CVS sold it to a debt collector I ended up paying them. It would have been much cheaper if I just had no insurance at all which now I don't.
Healthcare needs massive reform in this country, but United spends about the same (MLR - Medical Loss Ratio) as other healthcare companies. By law companies have to spend at least 85% of their premiums on medical care and can't pocket any excess profits, so there is no incentive for them to reject more claims and they aren't even reaching the 85% mark as they are at 89% right now.
This is more likely a function of the fact United offers a wider range of bronze level plans and is more active in the ACA reporting areas used on data like this. And because they offer a larger variety and more heavily target bronze level markets, they obvious get higher rates of denial due to the obvious fact the more bronze plans you offer the higher your rejection rate will be as a portion of your total offering portfolio.
That threshold only applies to large group plans. Self-funded employer-sponsored plans, which is how 2/3s of all workers in the US are covered, aren't subject to MLR rules at all. On top of that, individual and small group markets only have to hit 80%.
And insurers that have bought up hospital systems, doctor practices, and pharmacies can pay their own subsidiaries inflated prices, count that as “medical spending” to satisfy the ratio on paper, and keep the profit inside the corporate family.
I wish they would have at least alluded to the inflationary pressure providers contribute to claims costs. Many insurance contracts just shave a percent off of what is charged, which is pressured by the provider’s own investors.
Look at all the private equity invested in health care.
Pointing out of a single "worse" insurance company really misses the point of why the system is so broken. It's not due to individual insurance companies being a little bad or pushing the limits of what they can deny. It's way more systemic.
I still don’t understand why the US health Insurance industry isn’t the biggest and most illegal conflict of interest ever. How can a company that has a financial gain from denying claims be trusted to decide medical necessity.
It's not a conflict of interest if the system is doing exactly what it was designed to do which is extract premiums and hoard the cash. The health part was just a marketing gimmick and still will be.
Its good business practice by United. Its job is to make a profit and a solid return for investors. Providing care is secondary tonthe function of insurance. And why we need universal single payer. Health care should not be a profit based activity.
I had a botched double jaw surgery with the only in network doctor within a 100 mile radius. It has completely ruined my life, and I have been consumed with trying to fix what they broke. Currently over $100,000 down and on my 3rd jaw surgery. Suffice to say, I celebrate Luigi.
I’m going to parse this and infer that their insurance forced them to a surgeon with a less than stellar rating whereas a better surgeon may have avoided this outcome.
Let me fix your analogy up a little. The roofer is wildly unqualified because that is all the insurance will pay for. The homeowner's roof collapses a week later and insurance refuses to pay for anything.
Odd how you show so much empathy for a health insurance CEO, but none for my situation. When you have a family member rot away from cancer that could have been prevented had insurance not drug their feet on treatment, maybe you will have a change of heart.
There's no empathy for the CEO, it is lack of empathy for you. From your perspective, it is okay to murder said CEO. I do not share that point of view. I can understand that your situation sucks and I still do not think that justifies killing another human.
Idk how you can read all these comments talking about UHC's actions that caused life altering consequences to millions of people and not be able to see why anyone would celebrate the CEO's murder.
I celebrate the CEO's murder the same way millions of people celebrated Ted Bundy frying. I view them one in the same as any sane person would.
UHC forced me into a surgery with a widly unqualified surgeon and it has completely ruined my life. I'm glad he is worm food. May he rot.
Look on the bright side: you may never be sure exactly what you're paying for when you trying to cover your health, but the insurance company will always get the full premium regardless, so you don't have to worry about them losing money.
Why dont people boycott this shithole company? Even at my crappy job, I got to choose providers and I definitely didn’t even think twice about my “hell naw” when I saw them on the list.
The sad thing is, everyone who is invests in high-cap or total-market index funds—which is to say, pretty much everyone who invests—probably owns a piece of United Healthcare.
Have you seen their latest ad campaign? It has UHC "employees" talking about how great it feels to help people navigate the health care system. Says about all you need to know about UHC.
Question: Why do people still go to UnitedHealthcare for health insurance after all this? Feels like throwing premium money out the window for nothing…
They have an obligation to weed out overbilling, unnecessary procedures, and outright fraud. What do you think they should do instead? They're not an infinite money machine.
Strange how the rest of the industry has significantly lower rates of overbilling, unnecessary procedures, and outright fraud.
That must be it. It couldn’t possibly be that UHC intentionally denies valid claims as part of their business model knowing that many won’t bother to appeal.
Reason why they was saying rip to they ceo insurance companies shouldn’t be allowed to be on the stock market they put investors and stock interest before customers who the the reason they making money
That's why in the Netherlands, health insurance companies cannot be for-profit.
That means no profit payouts to management or shareholders. Profit must be kept in the organization.
The US “free market” healthcare is more like being walked into the mob’s overpriced grocery store with a gun to your head, being told it would be a shame if you didn’t like anything you see.
You can’t really get the capitalistic benefits of a competitive marketplace from products when the alternative is a game of Russian Roulette.
The flip side to not denying claims is fraud and abuse.
How many times have you run into a doctor that pushed unnecessary labs and procedures?
I’ve had it happen so many times now that I’m pessimistic about the medical profession. They should be required to disclose their financial relationships to drugmakers when recommending drugs.
It is a bit of a misdirection but also overall a valid claim. Healthcare is rife with fraud + abuse driven by rent-seeking behavior and incentives that are misaligned with patient outcomes
Yes, but generally not through unnecessary testing as initiated by providers. The providers engaging in systematic unnecessary testing are generally very new/poor mid-level clinicians not comfortable in their own decision-making, actual quack noctors/chiropractors and "functional medicine doctors", etc - Practicing physicians as a group of people do not generally over-order
Also calling bullshit and asking to substantiate on nebulous kickbacks and asking them to bring more than just, "Yeah I bet they're getting paid somehow! (?) to give their patients the medications needed to address their specific disease processes"
Yeah my original comment should have been narrower. I was agreeing with only the first sentence of the other comment - I intentionally try not follow this sector closely anymore so can’t speak to those other claims
> The flip side to not denying claims is fraud and abuse.
Often it's to cover all of their bases, since the US is a liability nightmare for physicians. Why not order a CT scan just in case, when the lack of ordering one could be used against you in a malpractice case? This is where single-payer systems win a bit in terms of efficiency, since the government-imposed rules on what procedures and tests are necessary and when are more consistent and strictly laid out.
And then sometimes the doctor will genuinely be ordering the most effective medication or procedure, but just without regards to its cost. Let's say that there is a newly patented cholesterol medication that is effective in 99% of the patient population, whereas the old generic one is only effective in 90% of the patient population. Well, as of today, it's up to the individual insurance companies to deny the new, expensive, medication unless the old one is tried first. Doctors themselves, however, have no incentive to do that cost comparison. If every patient on the generic medication was to be switched to the new, patented, one, then everyone's insurance premiums would rocket upwards, for only a marginal improvement in health outcomes overall.
Just look at the rate we perform hysterectomies in the US to any other G7 country (it’s almost 40% of all women by 60). Or c sections. It’s seen as a freebee in this country.
The Hysterectomy rate in the US is roughly 20%, not 40%, and has been falling for decades. The rate was higher in the 20th century due to gynecologic cancer being more common and harder to treat - smoking was a major driver of this.
If you go back and reread my comment, you’ll note that I said by 60 almost 40% of women will have had a hysterectomy.
You then replied that’s false the overall rate is about 18%.
It is not false - on average 1 in 5 (roughly 18% as you quoted) women have had their uterus removed. By the time they reach 60 that number jumps to about 40%. By 70 it’s about 1 in 2.
Do you understand?
Here’s the source:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10643045/
if you read the study i linked, the conclusions specifically note that the overall percentage of woman in the US who have had a hysterectomy is 20%, and that the widely reported 40% number is incorrect.
I work in it at a hospital and the billing people constantly complain about how difficult united makes it to submit claims. It isn't a bug, it's a feature.
Lmao you know how overworked most doctors and hospital staff are? Unnecessary labs and procedures give me a break. What a ridiculous anecdotal exaggeration
I love being in Australia where we have much more freedom to request tests and investigations as indicated clinically as opposed to some accountant telling us what we can and can’t do for just about everything because of cost metrics.
In socialized medicine you still have an accountant telling a doctor what to do lol and it’s way worse because they also dictate exactly how much you get paid.
Single payer destroys medical professionals salaries and it’s why a McDonald’s manager in the US makes as much as a doctor in Japan.
This is a minor issue compared to the much larger systemic issue of claims denial and intentionally byzantine healthcare plans. Oh, this doctor is out of network, oh that procedure didn't have prior authorization, oh we're changing what medicines we cover, etc.
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Stt022 | 12 hours ago
They denied some orthotics for me. I appealed and just pasted the section of my plan that says they were covered. They eventually paid but how was it even denied in the first place?
R3luctant | 12 hours ago
For a period of time I think their process was to deny first and then wait for the appeal, hoping some people would just pay out of pocket.
Possible-Buffalo-321 | 12 hours ago
Deny, defend, depose
Samanthacino | 12 hours ago
A valiant hero of the working class, he is
JB-Wentworth | 12 hours ago
Saint
Possible-Buffalo-321 | 11 hours ago
I still don't believe the baseless accusations. It could not have been him; he was at my house that whole week.
Square-Ambassador-77 | 7 hours ago
Remember when we all played rock band and he was going crazy on guitar? Guy literally had every eye on him the whole time.
ApolloGR3 | 7 hours ago
Yeah I remember him insisting we stop using practice mode and everyone immediately got better once we could fail a song
Possible-Buffalo-321 | 4 hours ago
That guy! Where would we be without him. I can't wait for this whole thing to blow over so we can jam again.
MightyCaseyStruckOut | 9 hours ago
This is true. As I distinctly remember, we all hung out a few times that week.
mologav | 11 hours ago
He’s not working class. You mean hero for the working class
Samanthacino | 10 hours ago
Mmm I'd still say he's working class. He isn't of the owning class, he still has to work for a living. He isn't surviving merely off of asset accrual.
mologav | 10 hours ago
He’s upper middle class at least. His family are wealthy. You’re clutching at straws if you say that everyone who works is working class.
JannyStabberXK4000 | 10 hours ago
Regardless of how much you are paid, if you have to actively work to survive, you are working class and are not of the ownership class. Full stop. End of story.
mologav | 10 hours ago
My father worked every day of his life and owned multiple millions in property, he was working class by your definition?
MgDark | 10 hours ago
but he DID have to work? thats the question.
Im going to do a big guess that if he could delegate his property and business and just live of that profit, then hes ownership class. Some people just dont like being idle, but there is a big difference between working because you WANT and working because you HAVE to.
TrillegitimateSon | 10 hours ago
>>have to
Melancholic_Noodle | 10 hours ago
Did he have to work or not?
If your father worked out of love for his job or pure greed then sure he's owning class. But if he had to work to continue to have a good life the he's working class.
Or even simpler. Could he take a 6-8 week vacation just for fun any time of year without it impacting his financials? Could he go into a coma and live off assets for the rest of his life? If not then he's working class
Owning class is Musk, Gates, Bezos. They could be be in a coma for decades and they'd not even notice.
bobs_monkey | 8 hours ago
Yes. Effectively, unless you're a billionaire in the modern era, you're not part of the top club.
There are basically two sets of people in the world: Those at the top, and everyone else.
In the words of George Carlin: "It's a big club, and you ain't in it."
IronWhitin | 7 hours ago
He has do some work in the right direction, so It Is working class
IsayNigel | 11 hours ago
Pedantry
helpmehomeowner | 12 hours ago
This is why their ceo was denied.
rpc56 | 11 hours ago
Well fucking played! Well fucking played!
RileyGainesHorseBaby | 8 hours ago
That appeal process might also get an auto-rejection as well.
ZetaM3 | 6 hours ago
CEO of a division within the company, not the actual CEO.
Butterfly_Mine_69 | 6 hours ago
It's okay, it's just a CEO they can replace it
eetsumkaus | 12 hours ago
Can people sue for this as a class action?
0WatcherintheWater0 | 10 hours ago
Already are. UHC is involved in multiple major lawsuits over this kind of thing.
tissuecollider | 7 hours ago
What's fucked up is that shareholders threatened a lawsuit after the killing because UHC started approving 'too many' claims.
Shareholder value is a cancer on humanity.
0WatcherintheWater0 | 15 minutes ago
The shareholder lawsuit was over them misrepresenting future projections, not over any change in the claim approvals themselves.
Santsiah | 6 hours ago
It’s the law. The purpose of a company is to create value for its shareholders.
Edit: I realized this may read like I am defending the system. I am not.
Rodot | 7 hours ago
Technically, anyone can sue for anything as a class action. Whether or not it will succeed is another story
12-34 | 6 hours ago
This isn't really true.
Class actions are not individual lawsuits, which require no automatic additional step from a judge to proceed.
Class actions, on the other hand, generally require certification of the proposed class by a judge. That means they need to meet the criteria of a class action to proceed as a class action, otherwise people must sue individually.
There are 4 variables duye a class under federal civil procedure to be met -- which would likely be the jurisdiction of a class action against UH -- but states can have their own verification rules. That said, states generally ape the feds' class rules.
Butterfly_Mine_69 | 6 hours ago
They can try, but United will just bribe their way to victory
spongebobisha | 11 hours ago
Essentially this. They probably want to test if the applicant has the patience to fight the denial or not.
EconEchoes5678 | 8 hours ago
You are correct and this is essentially the biggest reason why US healthcare is so broken and expensive.
However, this is not a fault of the insurance companies. They have to deny some claims. Denying some care is a normal part of every healthcare system on the planet - but in UHC countries the denials are more structured and handled more efficiently and cleaner (top down + doctor-level).
We have foisted the role of gatekeeper onto the insurance companies. They're terrible at this role, but it's one of the key roles they have to play. To fix this, we need to move the gatekeeper of care. This change alone would make a major difference in US healthcare costs (though not as good as an actual UHC system).
Haemophilia_Type_A | 7 hours ago
I mean there's a big difference between healthcare being "denied" (not really a word that makes sense in the context of universal healthcare) because it's not medically appropriate and healthcare being denied to maximise profits.
I mean in the UK you just get the treatment that the doctor says is medically correct. It's not really being "denied treatment" if you (for some reason) want something random that's not relevant to your issues. But you won't be denied doctor-recommended treatment for monetary reasons or whatever.
This idea of "claims" as a whole just doesn't exist in countries w/ universal healthcare.
EconEchoes5678 | 7 hours ago
> healthcare being "denied" (not really a word that makes sense in the context of universal healthcare)
It is. Look up how QALY decisions are made, for example in the UK. Someone has to decide how to allocate the scarce resources. Demand for healthcare is nearly inelastic and unlimited. Someone has to decide where we draw the line.
> because it's not medically appropriate and healthcare being denied to maximise profits.
Once again you're over simplying this. Profits in the healthcare industry are relatively small. The core problem is a problem of scarce resource allocation and unlimited demand. Someone must decide how the resource gets allocated.
> I mean in the UK you just get the treatment that the doctor says is medically correct. It's not really being "denied treatment" if you (for some reason
Yes, you are never told of alternative options, diagnoses, or treatments. You are diagnosed and told the step treatment to follow. You're not told about the experimental treatments that might help youb- even when they might actually be what you need. Because the board above the doctor has already decided how to allocate the scarce resources and the doctor is simply informing you of how it works.
There's a ton more options. There's a ton more tests and potential solutions, step treatments that you could have skipped but were required to do. You have to hope the board gets it right (and they usually do). But it's still a scarce resource allocation system, it's just handled with a 5 minute doctor conversation instead of 87 calls and letters to the insurance company.
Don't get me wrong it's a much better system. We need it in the US. But I want people to be honest about what the problem is.
DogBarf00 | 7 hours ago
> I mean in the UK you just get the treatment that the doctor says is medically correct.
Only if it’s been approved by the NHS.
> But you won't be denied doctor-recommended treatment for monetary reasons or whatever.
Yeah you would be. The NHS still has a finite budget. For example it won’t spend 30 million pounds on end of life care on a dying 96 year old grandma to give her another week.
Haemophilia_Type_A | 7 hours ago
There are some value-for-money evaluations done by NICE (not the NHS), but only for things with unproven or poor efficacy.
Expensive treatments that work are still approved.
Yes there are infrastructural limitations, but that's completely different to standard and needed/proven medical procedures being denied to maximise profits.
bloks27 | 12 hours ago
This has happened to me a few times. Based on how much I make per hour, it isn’t worth going in circles with insurance for 4 hours on my day off to get them to cover a few hundred bucks. It’s infuriating honestly.
TrayLaTrash | 12 hours ago
Their plan worked.
ChilledParadox | 11 hours ago
if you make a few hundred in 4 hours you could probably pay someone like $40 to handle it for you lol. it'd be worth my time, im still unemployed :(
smegabass | 8 hours ago
Sounds like a great business plan for an AI platfilorm. GetClaimPaid.com
Substantial_Pick6897 | 6 hours ago
They've done that in my country with flight companies refusing to pay stuff back
Key-Asparagus-7851 | 4 hours ago
I am working on a prototype and am searching early beta users to help me shape the product. Please reach out via DM if interested in contributing.
bloks27 | 10 hours ago
I don’t want to share my private health information with a stranger. It feels simpler to just pay the money - happens maybe once or twice a year, so it isn’t often. It’d be nice if insurance just covered what they say they will cover without a fight, but we continue to allow the insurance companies to run relatively unchecked and unpenalized for things like that.
atxbigfoot | 10 hours ago
> It feels simpler to just pay the money - happens maybe once or twice a year, so it isn’t often.
Welcome to how they're profiting off of you and everyone else who simply can't afford the time to argue the over charges, lol.
"The less people that argue, the better our numbers look! How do we make sure less people argue our charges?"
"What if we sent smaller ones to rich people who don't check or even care, and also poor people who can't afford to fight them?"
GENIUS
melkatron | 10 hours ago
I think they're suggesting you employ a trusted assistant for $10/hr to do this and other things for you daily... so basically just find an idealistic youngster and rope them into work that won't translate into experience for any meaningful field and pay them poverty wages.
Otherwise_Demand4620 | 10 hours ago
> a trusted assistant for $10/hr
you're looking for a child sidekick with that budget:
https://i.imgur.com/39IqwCb.png
TheMentallord | 9 hours ago
Not gonna lie, that is 100% down to your government and justice systems not cracking down on shit like this.
In my country, I never heard anyone having issues with not getting pay/copay activated via their insurances.
ChilledParadox | 10 hours ago
no, i wouldnt recommend you do it to a reddit stranger either, but theres probably a decent middle ground that exists, someone you can personally trust, whether an institution or a person. Seems like it would be worthwhile if you're really getting fucked by insurance like that.
Otherwise_Demand4620 | 10 hours ago
> an institution
get your insurance insurance, we strong-arm your insurance to pay out. Also inquire about our insurance insurance insurance!
roygbivasaur | 11 hours ago
It’s a nightmare trying to get insurance to pay for a CPAP. They send you to the worst DME place in your area who doesn’t care about your brand preference and won’t even just give you the same model that you already had (the motors and gaskets all break and eventually the internal computer won’t let you keep using it even if you repair it) or the newer version of the same model. Then, they charge full price and you don’t find out if your insurance is going to cover it even if you’ve already hit your deductible. So you might end up paying $1200 for a machine that reasonably should be $200.
If you’ve got $500, you can just skip the whole mess and send your prescription to an online store and hopefully get credit for it on your deductible (by submitting a form) and take 3 days to get a new one instead of 2 months. Then you can tell the DME place what machine and mask you use and they’ll set up your supply order and make sure your insurance adds it onto your deductible, though you will still pay out of pocket for that.
And this is on a PPO plan. I’m sure it’s worse for HDHP
Ateist | 7 hours ago
Sounds like unsubstantiated denials should be punished by fines and subject to lawsuits.
musical8thnotes | 11 hours ago
You're definitely not getting your money's worth.
medpupper | 10 hours ago
We all need to be petty and fight it
bloks27 | 10 hours ago
I simply don’t have the time or energy for it. If they deny me a $200 charge, that’s less than two hours of work for me to eat the cost or it’ll be an entire afternoon on the phone going in circles and being stuck on hold for a *chance* of insurance picking up the tab. I fought that stuff years ago when I was in my early 20s making $35k/yr, but it just isn’t worth it to me anymore.
SnugglyCoderGuy | 11 hours ago
That's some Great Benefit, from the movie The Rainmaker, shit
ariukidding | 11 hours ago
It’s the same modus like your parking tickets. They’re banking on people to just give up and pay. Since alot of people really have no choice but to appeal, atleast they were able to weed out some people and that they got a statistic that looks good to shareholders. Capitalism shouldn’t affect basic human rights but we are in the end game here, Billionaires are investing to keep people where they are. The same idiots who get screwed are the ones voting for these Billionaire puppets.
medpupper | 10 hours ago
We need to collectively not give up.
SuchMatter1884 | 9 hours ago
>hoping some people would just ~~pay out of pocket~~ die
waigl | 8 hours ago
More like hope they weren't capable of appealing because of their health situation.
Melch12 | 6 hours ago
They do the same thing in hospitals where people are looking for services (therapy, nursing) and placement (rehab) after an admission. They run hospital staffs ragged because they deny a safe discharge plan (determined by actual clinicians) for people and effectively keep the bed occupied with a person that doesn’t need to be in the hospital anymore, thus preventing another person that actually needs a hospital bed from being admitted. United also takes a very long time to review the case (on purpose) to delay the discharge as long as possible in the hope that the patient/hospital staff gets fed up and leaves anyways. They’re a parasite on the healthcare system but they’re far from the only one. Humana comes to mind as well. Coincidentally, people with government funded healthcare (Medicare) don’t run into this issue nearly as often.
HetoHwdjasZxaaWxbhta | 9 hours ago
Not sure that stopped
Mission_Context_8079 | 7 hours ago
That’s how SSI seems to work. Deny and hope for attrition.
artvandalaythrowaway | 6 hours ago
Anybody who thinks they know how health insurance works needs to watch The Rainmaker. Insurance companies are all Ponzi schemes where they collect as much premiums as possible and pay out absolutely the bare minimum was possible. Their profit margins only come from minimizing overhead/operating budget and minimizing payouts. They are financially incentivized to deny reimbursement at every turn. They are only checked by government regulation and lawsuits, and they will always do the calculus of whether the macroscopic profits of their practice justify whatever fine or lawsuit they have to settle.
knightress_oxhide | 11 hours ago
this actually creates jobs. if something is denied then presumably healthy people need to work to approve it. it is a job creation program which is good for society.
SnugglyCoderGuy | 11 hours ago
That's the dumbest shit I've ever heard.
umop_aplsdn | 9 hours ago
it has to be satire
EconEchoes5678 | 8 hours ago
It's actually a big part of how the system works. The gatekeeper of care in the US should not be with insurance companies.
knightress_oxhide | 11 hours ago
its the broken window philosophy that we are experimenting with. it isn't going that well... but you gotta try everything once right?
SnugglyCoderGuy | 11 hours ago
You really don't
knightress_oxhide | 10 hours ago
but when our children's children want to try this, they will see it failed horribly and won't do it again. assuming history is still taught.
ICLazeru | 12 hours ago
If they deny and delay, some portion of the customers will give up. More profit.
H0bbituary | 12 hours ago
Some customers will die for those profits
Such_Radio_9152 | 12 hours ago
Funny how the 'death panels' are just insurance companies
BlasterPhase | 5 hours ago
but... but... socialism!
East-Ice-3199 | 12 hours ago
The board members don’t care
UKEE93 | 12 hours ago
Well there was this one time that they suddenly started caring…..
East-Ice-3199 | 9 hours ago
For like a week. Then they brought in a new CEO who’s doing the same shit.
Test-NetConnection | 12 hours ago
The CEO did
East-Ice-3199 | 9 hours ago
And the new one?
SnugglyCoderGuy | 11 hours ago
That's a sacrifice the shareholders are willing to make.
ICLazeru | 12 hours ago
Yup.
Maligned-Instrument | 6 hours ago
"Some customers will die for those profits" This is a feature of capitalism, not a design flaw.
Traditore1 | 8 hours ago
Sounds like a customer problem /s
PM_ME_YOUR_PRIORS | 8 hours ago
Even if they don't give up, the process makes the payout happen later, which means more time to collect interest on it.
Chemical-Drive-6203 | 12 hours ago
A friend of mine who runs a small healthcare company had to sue them for unpaid bills. They claimed they couldn’t pay because they got hit by ransomware and were using it as an excuse. 2.5 years of unpaid patient insurance. My friend had the choice of rejecting patients or eating the costs.
As soon as they filed lawsuit miraculously the money appeared.
StandardPanda3387 | 11 hours ago
I'm surprised you can even legally sue them considering the credentialing/contracts they have in place. In my state there isn't a statute of limitations for an insurance company to claw back claims they paid in the past. It's completely insane and soon there won't be any clinics left that take insurance. It'll all be cash pay or out of network only and that will have a disproportionate effect on people of lower socioeconomic status and those with serious medical needs. We always hear whining about death panels with a single payer system, but we already have those death panels in place now.
Chemical-Drive-6203 | 11 hours ago
I grew up in the UK. Healthcare system is generally very good. But because people who have only used the NHS complain about it they get a bad rap.
They have no idea how bad it is elsewhere in the world.
Dub-MS | 6 hours ago
This would actually be a better option. It would force doctors to compete on price. As of now, there is no transparency on pricing and numbers are just made up. Runny nose? Here’s a z-pack. That’ll be $4,000.
dombones | 12 hours ago
Automated denial system. The lawsuit claimed that they had like a 90% error rate. 9 out of every 10 decisions being reversed eventually.
Offloads the burden onto the consumer/patient and medical offices, leaving them to navigate archaic communication systems that are somehow on par with the government or worse. Mind you we are talking about a company with AI systems. Makes you wonder if they want patients to get the healthcare they already pay for.
The_Frostweaver | 12 hours ago
Even if people do get the healthcare on appeal a small delay means the insurance company got to keep that money earning interest for an extra bit of time instead of paying out immediately.
There needs to be a penalty for each denied claim that was wrongly denied.
After-Syrup1290 | 7 hours ago
Oh they get upto all sorts of bad things, the ai they use? Not to the patients benefits
Like, just yesterday a news came to me bout a nurse having to fight for her patient who had a surgery done, and had to stay the night in the hospital
Wanna know why they denied? To justify the stay in the hospital thingy... It's deliberate system, not out of neglect, but intent
The_Frostweaver | 7 hours ago
Agreed.
Thats why if an ai denies coverage, and then later it turns out they should have been granted coverage the company that used ai to initially deny should pay a penalty for that ai denial, in addition to any other payments or compensation.
No company should be allowed to issue blanket denial of coverage, via ai or otherwise, for things that are covered.
KehreAzerith | 12 hours ago
Because humans don't read claims, it's all done automatically by software that's designed to deny as many claims a possible to maximize quarterly profits
PomegranateSafe9699 | 8 hours ago
Yup. Got caught in the clearinghouse once. Where no human from the provider office, or the insurance company knew where or why my claim was getting denied. Clerical error put my sex as male on the claim, didn’t match my subscriber info. Kept getting denied then and there with no one at Cigna even seeing it/having record of receiving it. Took a year to solve the mystery of the $700 strep test.
Lizzy_Slander | 10 hours ago
this is so real, they literally built the system to fail you on purpose
1010_warrior | 12 hours ago
Watch “The Rainmaker”. It’s exactly about that!
https://m.imdb.com/title/tt0119978/
Stuffed-Bear412 | 12 hours ago
They have ai judging their claims and sending automatic denials.
Electrical-Eye-2544 | 8 hours ago
I wish more people knew this. It isn’t even healthcare humans, let alone humans, for round one! 😂 Always appeal!
Fluffcake | 10 hours ago
Because they can, there is no punishment for them wrongfully denying claims and making you fight them to pay, so they are making bank on people who are too sick, dying or dead to fight them, so they deny everything untill it would cost them more to keep fighting than paying.
Put laws on the book that makes them have to pay out 10x undiscounted cost in damages to patients if they wrongfully denies the initial claim, and 1000x if their wrongful denial directly cause provable harm or worsened prognosis for the treatment. And suddenly this practice magically evaporates...
People didn't cheer when the CEO got murdered for nothing, this company and the entire industry is a blight.
EconEchoes5678 | 8 hours ago
> Put laws on the book that makes them have to pay out 10x undiscounted cost in damages to patients if they wrongfully denies the initial claim, and 1000x if their wrongful denial directly cause provable harm or worsened prognosis for the treatment. And suddenly this practice magically evaporates...
Sorry, this would not work. It would massively increase costs for everyone. Insurance company profit margins are not very big and these costs would just be passed on.
You have the right idea but this is way, way too punitive. Denials of care requests are normal in every country including UHC countries. They just handle it much more efficiently and with strong cost-aware, fair policies. The U.S. forces insurers to do the "cost aware" part and to be the gatekeeper of care, but they are not good gatekeepers. To have a better system, we need to move the gatekeeper of care. If we do implement consequences for denying care, the consequences need to be reasonable because denials are a normal occurrence in healthcare.
Fluffcake | 7 hours ago
> way too punitive
It is not supposed to be punishment, it is supposed to be deterrence to enforce and reward competence. If they do their job right instead of rubber stamping denials, they have nothing to worry about. The only times you get denied care in UHC countries is if it is not an approved treatment, only really happens with cutting edge treatments or new drugs or if your doctor can't come up with a medical justification for the treatment, like healthy people wanting ozempic to stay skinny..
EconEchoes5678 | 7 hours ago
If you deter something that needs to happen as a fundamental part of the system, the system will break. Healthcare denials are a natural part of all healthcare systems because healthcare is allocating scarce resources. The difference is, UHC systems do it efficiently and sometimes almost invisibly. And it works better the way they do it. But that doesn't mean we can ignore the actual cause of our problem.
Fluffcake | 7 hours ago
There is no need for insurance to wrongfully deny coverage, this is what would trigger this. I am talking about insurance companies who willfully breach their contracts with customers as a willed business strategy, because it is more profittable than honoring it.
EconEchoes5678 | 7 hours ago
> There is no need for insurance to wrongfully deny coverage,
In the real world there is no magic button that decides "wrongfully". Medical situations are highly complex with a ton of nuance and other factors that have to be considered per patient. It is not possible to create a formulaic set of rules that can handle every edge case correctly.
> I am talking about insurance companies who willfully breach their contracts with customers as a willed business strategy, because it is more profittable than honoring it.
You're imagining that this is obvious and clear cut. And right now maybe, for some specific situations, it might be. All this law would do is slightly push back a small amount of the egregious violations back into the grey area. Insurers would get better at satisfying your law by denying more of the grey area stuff and avoiding crossing the line. But the core problems of our system remain, and we'll keep bleeding money and having worse outcomes.
Fluffcake | 6 hours ago
> In the real world there is no magic button that decides "wrongfully". Medical situations are highly complex with a ton of nuance and other factors that have to be considered per patient. It is not possible to create a formulaic set of rules that can handle every edge case correctly.
Anything is better than the current system where non-medical insurance staff makes life and death medical decisions that get people killed because it will make the shareholders a few dollar richer.
NotTakenGreatName | 12 hours ago
There are alot of reasons. I worked in insurance and the person submitting the claim could have made a mistake (they are often understaffed and underqualified), their claims system could have been misconfigured which can kick out the claim, your patient data or the provider data could have had problems, etc.
I think people don't realize just how many claims these companies receive, how many errors these claims often have, and how many of them are auto-adjudicated which means that no human being ever actually looked at the claim.
They also ofcourse don't really want to pay your claim either.
herefornothing2 | 11 hours ago
They’re not in the healthcare industry, they’re in the “pay shareholders” industry. That’s the problem with publicly traded companies.
EconEchoes5678 | 8 hours ago
Health insurer profits are not very big. The problem is a problem of efficiency and bad systemic design.
AbyssWankerArtorias | 11 hours ago
They likely deny most claims that aren't common in effort to whether people down and hope they don't keep resubmitting the claim. Wouldn't surprise me in the slightest.
Keyspam102 | 11 hours ago
I think they literally just deny across the board hoping you don’t Appel
TheAsianTroll | 8 hours ago
The CEO who was murdered by someone who isnt Luigi Mangione had approved an AI-based system to accept or deny claims quicker, shortly before his death.
The system denied about 90% of claims, but he accepted its implementation in that state anyway.
Just saying.
Busterlimes | 11 hours ago
Most people dont fight it. Insurance companies are a scam and should be illegal. They are probably some of the first that will be targeted as the proletariat goes after the bourgeoisie in the next few years here.
EXPL_Advisor | 10 hours ago
https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations
https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
Spirited-Tomorrow-84 | 10 hours ago
They are trying this with everyone I bet and it looks like it's working...
Active-Counter-9906 | 6 hours ago
What a bless living in Europe
MassiveBoner911_3 | 6 hours ago
They wanted you to just assume it wasnt covered and keep paying.
WalterSobcheick | 6 hours ago
The fact that the billers who billed the orthotics didn't do this is pathetic. But good on you. Most consumers would just pay. -context I was a medical biller for 10 years.
8v2HokiePokie8v2 | 6 hours ago
That’s exactly how this sort of stuff works unfortunately. Less people will be inclined to appeal, so they save money mathematically.
HarlanCedeno | 6 hours ago
I feel like I would respect UHC more if they just responded to my claims with "Fuck you, that's why".
immaSandNi-woops | 11 hours ago
There’s no accountability for wrongful denials unless someone sues. If there was process oversight, governance, and penalties to hold insurance providers accountable, then you wouldn’t be seeing as many denials. The issue would be much higher premiums and unhealthy people without health insurance.
SnugglyCoderGuy | 11 hours ago
Two letters
A
I
hateifyoumust | 7 hours ago
When I worked at an insurance company in TN one of our executive bonus metrics was percentage of initial claims denied. Yes, you read that right.
No_Remove4506 | 11 hours ago
Greed
notarobot1020 | 10 hours ago
It’s how they make money, clearly denying service pays well
rabbitthunder | 10 hours ago
>how was it even denied in the first place?
Because insurance companies realised that they could make more profit by not paying out.
It isn't just healthcare insurance,.it's pet insurance, car insurance, house insurance etc Insurers are refusing to pay or underpaying in the knowledge that lots of people won't push back. Healthcare insurance is particularly cruel because it's sick, dying and bereaved people who would have to fight back.
oritfx | 10 hours ago
Small bits and pieces. If you by default reject claims, some rightful ones will remain rejected. And since there's no downside...
Easy-Marsupial3268 | 7 hours ago
Capitalist greed.
gym_fun | 12 hours ago
National industry average for denial is 16-20%. The 33% denial rate is absolutely abnormal. Record profit should not come at the expense of people’s lives and health with those unethical practices.
Balgat1968 | 12 hours ago
What’s the difference between a Health Care Insurance Provider and a Hit Man? They both end peoples lives prematurely for profit. Differences? First, volume. One makes a shit ton more money and is entirely legal and pays great dividends to investors.
Such_Radio_9152 | 11 hours ago
https://en.wikipedia.org/wiki/Social_murder
zanotam | 7 hours ago
So from what I can tell the average economist is... well.... they think they're a social scientist who uses math... but that's an insult to those who've studied math (like myself) and those who studied social sciences (like most of my family lol). Buuuuut, as the autistic one of the bunch, I believe the correct generalization here is just the concept of "excess deaths" which is, admittedly, not anywhere as direct a term, but being able to point to "decision X instead of decision Y resulted in approximately N excess deaths" is... a much more concrete way to point out that someone made a choice and that choice means a lot of people aren't alive (which to anyone sane is obviously a case of murder!)
SlogurkTheOverslime | 4 hours ago
I think this is more about the distributed responsibility and our numbness to it. There is rarely a single reason why something happens. A combination of several tiny decisions made by unrelated people may have disproportionately terrifying consequences when combined. And it is neither necessary nor sufficient to figure out what the singular decision X was that lead to excess deaths directly, in order to figure out that the entire situation is fucked up and needs a major reform.
Such_Radio_9152 | 40 minutes ago
That analytical approach is designed specifically to minimize blame and chalk the phenomenon up to statistics, thus perpetuating the cycle that enables it
SlogurkTheOverslime | 12 hours ago
It's only murder when it's performed by tiny unorganized groups of people, otherwise it's just sparkling capitalism
OddlyFactual1512 | 8 hours ago
Unless that tiny group in comprised of very wealthy people.
Konukaame | 12 hours ago
One of their core lies is the denial of systemic violence. If they can hide murder behind a spreadsheet, it's just good business.
ThenOneDaySheWokeUp | 12 hours ago
I think I read somewhere that if you exclude UHC the average percentage for denials drops to 11%.
No-Caterpillar-7646 | 10 hours ago
That still seem abnormal. I would love to see some number for canada/uk or Europa.
BadahBingBadahBoom | 7 hours ago
You'd like to see the rate of denials of treatments that have been medically advised by a doctor in the UK?
Zero. It's zero. Because, and this is a crazy idea I know, if a doctor says you medically require a treatment you should receive the treatment. There are no middle men.
Blephotomy | 12 hours ago
Health insurers are required to spend 85% of premiums on healthcare or they are required by law to issue rebate checks to their members or their employers.
Thanks, Obama.
brianstormIRL | 11 hours ago
Yeah, out of insurance hospitals and pharmaceutical companies, Insurance actually makes by far the least profit because they're mandated to spend most of it on healthcare.
mweint18 | 5 hours ago
You mean the one that doesn’t actually provide a tangible product that carries massive overhead and responsibility is the least profitable?!?!
Um thats how econ works buddy, higher risk ventures need to have higher profit margins to justify the risks.
Turtledonuts | 9 hours ago
> National industry average for denial is 16-20%.
Which in of itself is far too high.
Easy-Marsupial3268 | 7 hours ago
But this is capitalism. Someone always pays so the rich can be rich.
4dxn | 12 hours ago
claim denials aren't the best way. it ignores efforts they do to prevent claims to begin with. medical loss ratios are a better metric, but even then, a lot of insurers also employ doctors and game mlr. you have to adjust for their internal medical cost inflation.
ChiLolla28 | 5 hours ago
Wasn't this also because they used an AI that rejected 90% of the claims it processed yet they were not charged with negligent homicide?
polygraph-net | 10 hours ago
I work in an unrelated industry, but it has the same business model.
When you advertise using the big tech ad networks, your ads will get loads of fake clicks. The average number of fake clicks by ad network is as follows:
So, if you advertise on Instagram, you have a greater than 50% chance of the click being from a bot.
The ad networks are supposed to detect these fake clicks, and refund them to the advertisers. But they don't. Why? Because every bot click and every denied refund is pure profit. The same business model as the insurance companies.
Conscious_Bug5408 | 12 hours ago
This is why Luigi is considered a hero among so many Americans. Dramatically improved claim approval in the immediate aftermath, to the point UNH was sued for approving claims
Special-Garlic1203 | 11 hours ago
I had a teacher in high school who had worked at United before having a crisis of conscience. He talked about it in one of our classes related to the Ford decision and the reality of the system we have created. He did not explicitly but very pointedly used framing to compare it to the Holocaust - the mechanized killing where every person could have the psychological distance to not feel they were killers, and where everyone kind of shrugs and goes about their day because it hasn't yet been their loved ones the machine is eating.
Special_Order-937 | 9 hours ago
The insurance scene in Fight Club was based on the Ford decision or one like it, wasn’t it?
ClientBudget2848 | 8 hours ago
Yes. Its not like this was the only time that formula was used. Bet they kept using it.
Capitalism does that when it goes too far. It sells lives in exchange for more money.
zanotam | 7 hours ago
I like to point out something similar in politics - everyone who voted for Trump in 2024 voted for the decision to close USAID... which is going to cause at least a holocaust worth of deaths while also fucking over American farmers and putting a bunch out of business. Like, you can say you just voted for the President, but there sure are a lot of dead poor people in the world 2 years later because of that and that number is increasing at a faster rate now than just a year ago...
collectivebarganing | 7 hours ago
What is the Ford decision?
MSgtGunny | 6 hours ago
I believe they are referring Dodge Brothers vs Ford motor company, which was the case that cemented that investors interests were the primary concern for the executives at a company, not long term company or worker well being.
Samanthacino | 12 hours ago
Luigi Mangione was directly responsible for saving the lives of innocent Americans. We should all aspire to be like him.
Spare-Ant7119 | 12 hours ago
We don't know that. He is just a suspect on the case currently. Don't jump to conclusions.
butterycrumble | 9 hours ago
Didn't the insurance companies start approving more as fear there'd be copy cats. Obviously they didn't do it for long
Beginning-Pop3127 | 8 hours ago
Direct action works. Now we just need a lot more of it
zanotam | 7 hours ago
Well, kinda. There's a reason anarchists stopped doing it which seemed like a pretty damn good reaosn at the time (on account of accidentally starting fucking World War I....)
critacle | 6 hours ago
No, they hid their C-levels from their websites. Probably because they felt they were in danger from their own actions.
echobeta12 | 11 hours ago
They must let him go, he was right there with me at the pub for happy hour, the whole time too!
bobs_monkey | 8 hours ago
He and I we're having breakfast in Miami around the time they claimed he was in NYC. Shenanigans.
bak3donh1gh | 9 hours ago
Between how they found him and how they treated the evidence after they found him, there is plausible deniability Right there whether or not he is or isn't guilty. the guy was fully masked up His eyebrows don't match.
CPTRainbowboy | 9 hours ago
We should all kill random people without trial so they can be replaced by the next guy who does the board of directors bidding?
Sound logic, but go ahead!
CurryMustard | 8 hours ago
>Thompson's murder resulted in a massive strategy change: that it wasn't willing to pursue its widespread claims-denying "as a result of heightened scrutiny...as well as open hostility."
At least according to this lawsuit, more americans had their claims approved as a direct result of their ceo's death. So this isn't one ceo being replaced by another and business as usual. This is meaningful change that directly impacted the lives of thousands of americans who otherwise wouldve had their claims denied to boost the share prices.
https://finance.yahoo.com/news/investors-unitedhealth-greed-got-ceo-172053915.html?guccounter=1
CPTRainbowboy | 8 hours ago
I mean. Lawsuits can say whatever they want. They still have the highest denial rate.
Also: is this really the way you want to make changes? Don't like it? Shoot em!
MellowMercie | 8 hours ago
I think most people would like to not shoot people to affect change. Not saying to shoot people myself, either. But you can't be serious. People have been pushing for medicare for all for decades. We haven't gotten it. It's looking like we're just as far away from it now as we were 20 years ago. We are the only developed country in the world to not have universal healthcare. People have been trying through the legal channels, and it's gotten them nowhere.
CPTRainbowboy | 8 hours ago
You think the rest of the world got healthcare by shooting ceo's?
'we shoot CEO guys because we don't have a healthcare system, and that makes it ok' is a funny argument.
MellowMercie | 8 hours ago
Maybe not CEOs specifically, but generally yes people tend to get rights as a result of violence or the threat of violence.
CPTRainbowboy | 8 hours ago
Weird how the rest of the world has healthcare without shooting ceos.
MellowMercie | 7 hours ago
Totally ignoring what I said. Lol.
zanotam | 7 hours ago
... where do you think almost all worker rights come from? see, when a mommy anarchist and a daddy liberal team up to fight the battle of blair mountain... or team up to write a book about the meat industry... or threaten the lives of racist southern whites on one hand while peacefully marching on the other...
awry_lynx | 8 hours ago
It's not the way most people want to make changes, given the literal fact that most people aren't doing it, but it is also wrong to act as if it is not an effective way to do so. c.f. most changes in human history?
That said, I am a proponent of nonviolent resistance instead of random assassinations. I absolutely do not trust 'the masses' to commit a bunch of killings to any positive effect for society. I mean, The Singing Revolution worked. It's just hard to get cynical people on reddit to be anything other than pointlessly reactionary.
CurryMustard | 8 hours ago
Im not condoning violence, but its pretty clear our government has failed its basic duty to protect the citizens in the US. And when the government fails, well this year we are celebrating the 250th anniversary of shooting people we disagree with for freedom.
CPTRainbowboy | 8 hours ago
Not condoning voilence. Except when a guy shoots a ceo, making arguments why he deserved it.
CurryMustard | 8 hours ago
You said it would be business as usual when they replace the ceo with the next. I was merely countering that claim.
>Mr. Thompson’s death also forced a public reckoning over prior authorization. In June, nearly 50 insurers, including UnitedHealthcare, Aetna, Cigna and Humana, signed a voluntary pledge to streamline prior authorization processes, reduce the number of procedures requiring authorization and ensure all clinical denials are reviewed by medical professionals.
https://www.beckerspayer.com/payer/one-year-after-ceo-killing-unitedhealth-navigates-a-financial-reset/
bak3donh1gh | 9 hours ago
Random people? Really dude?
You're gonna support the death machine in this topic?
Brian Thompson served as CEO of UnitedHealthcare from April 2021 until December 2024, a tenure of roughly three years and eight months.
During his time leading the largest health insurer in the United States, his key decisions and operational impacts included:
Massive Profit Growth: Under his leadership, UnitedHealthcare’s annual profits surged from 12 billion to 16 billion. in 2023, while the parent company saw revenues top $281 billion annually.
Denials: He led a firm that increasingly relied on automated claim denials and algorithms to limit coverage for procedures, therapy expenses, and post-acute care. These stringent cost-cutting policies led to intense scrutiny, including government investigations and class-action lawsuits.
Oh, he was so innocent killing all those people. Indirectly, of course, because it's fine when they're just a number on a page. Just like you.
To be clear, I'm not saying anyone should k!ll you, H@rm you or anybody else. No one should commit violence against anybody else, in a perfect world.
CPTRainbowboy | 8 hours ago
That just sounds like an essay on why murder is fine.
Did the company change course dramatically? Or did the ceo just get replaced.
And where is the line of 'doing enough wrong to murder someone' exactly? Can vegans go out and kill farmers? Can everyone go out and kill trump?
Yes, street justice feels good sometimes. But maybe the world gets a whole lot worse if we all kill whoever wrongs us.
Ok-Parfait-9856 | 8 hours ago
And yet you ignore the reality, where wrongly denied claims has killed countless people. Don’t act like you have the moral high ground.
CPTRainbowboy | 7 hours ago
Show me those countless people.
zanotam | 7 hours ago
They're.... they're literally dead.
CPTRainbowboy | 7 hours ago
Oh my god! And nobody wrote articles about it? Nobody analyzed the hundreds of thousands of deaths? Thats so convinient!
zanotam | 6 hours ago
My brother in christ, you are literally commenting on the page linking to an article about it.
bak3donh1gh | 8 hours ago
An essay? Man, when was the last time you wrote a fucking essay? if you can't see moving to not cover things that they are supposed to cover and a massive profit increase and can't see how those two things might be intertwined, You might be willfully ignorant because you're on the payroll.
I am not advocating vigilante justice, but Take a look at history and see how things changed in the past. that'll lead you to maybe an idea of how things will change in the future. Because peaceful protests don't work in a system like the American one.
I have a dream. The grassy knoll.
I think you're okay with thousands of Americans dying every year by preventable illnesses, and the line is somewhere before that, and you're just not caring because it doesn't affect you.
CPTRainbowboy | 7 hours ago
I am not advocating vigilante justice. But here's why it is acceptable. Good one.
They aren't dying because of that ceo, they're dying because the politicians don't do anything about it. Keep voting trump, it will get better in the third term.
Tea-acH-Cee | 8 hours ago
So the board should be targeted?
CPTRainbowboy | 7 hours ago
Nobody should be targeted, but a ceo is just extremely dumb.
The_Real_BenFranklin | 11 hours ago
He killed a young father.
DigCautious4405 | 11 hours ago
Whoever actually killed Brian Thompson killed a middle-aged mass murderer. Just because you end someone's life with a pen instead of a knife doesn't make you more innocent.
Luigi, on the other hand, is completely innocent and was with me and twenty other people having a pizza party.
hungry4danish | 11 hours ago
Just because the CEO ejaculated into a woman and that woman carried to term does not make him a good guy.
How many fathers were denied life saving services while he was CEO?
Johnclark38 | 11 hours ago
He killed a monster
integer_hull | 10 hours ago
And how many young parents has Brian Thompson killed
Samanthacino | 10 hours ago
In doing so, he saved the lives of many more. Stopping a mass murderer from inflicting death to innocents is something you won't see me crying about, especially if it leads to other killers stopping in their tracks as well.
bobs_monkey | 8 hours ago
The oligarchs won't pat you on the head and give you a slice of bread until you cradle the balls and massage the tip with your tonsils, so keep trying.
rockerswise | 10 hours ago
Yeah I’m sure his parents are really proud he murdered someone
TheLastPeanut_ | 9 hours ago
Can we get a sequel?
whooptheretis | 7 hours ago
Hasn't he maintained his innocence?
He hasn't been found guilty, why are you assuming he is?
AgITGuy | 6 hours ago
I think it could be better said that regardless of his innocence or guilt, Luigi has become a beacon for the American people at large due to his arrest for what has become a poignant and important incident that directly led to more people getting care approved.
whooptheretis | 6 hours ago
But it’s yet to be seen whether or not he actually had any involvement with it.
mister_empty_pants | 11 hours ago
Healthcare providers are required to pay out 85% of collected premiums. It's the law. Anybody telling you numbers about claim approvals or denials or record profits has a dishonest agenda.
Such_Radio_9152 | 11 hours ago
Because the law ever stopped any of these unscrupulous insurance companies from doing anything to boost their profits... Especially with this administration that treats the constitution as if it was toilet paper. If they ever do get caught, after a decade long legal battle with their army of lawyers defending them, they'll just pay a small fine and that's just the cost of doing business. Meanwhile those profits just keep rising.
mister_empty_pants | 11 hours ago
If you have evidence of securities and accounting fraud at a major healthcare provider is taking place, then get the fuck off of reddit and do something.
Unique_Adeptness4413 | 11 hours ago
Can you think of any examples of broken laws that go unpunished that exclusively benefit the rich?
whinenaught | 11 hours ago
What does boot taste like
NotADumbPuppet | 10 hours ago
Hey dipshit, you do know that such evidence and fraud needs to come internal whistle-blowers or via investigation? Which has happened multiple times.
How about testimonial yields from their customers that they're being unfairly denied? Because there's plenty of those too.
You think you're smart but you're actually simpleton as fuck.
During 2007 your dumbass would probably be saying: "If you have evidence of securities and accounting fraud at a major financial institutions is taking place, then get the fuck off of facebook and do something."
You see how low brow of a statement that is? Never go around pretending to be mr gottcha. You are the last person thats gonna gottcha someone with the dumbest statements.
Conscious_Bug5408 | 10 hours ago
Full disclosure: I am employed by United Healthcare
You are correct that the ML ratio is a law enacted by the ACA. 85% of premiums must go to medical claims. Some stick closer to that, and UNH has set goals for that metric.
However, there isn't a law regulating whom profits from the payment of those claims. UNH directly owns vast healthcare businesses, PBMs, Optum etc. This allows them to reap financial benefit by paying those claims out to themselves when the insured use medical providers and servicers under UNHs direct ownership.
This is a way they can benefit from their notorious rate of claim denials. Denying more claims but simultaneously paying fatter claims to their own healthcare businesses keeps them legal with the 85% rule while juicing the profit margins of their business and thus themselves. Paying those fatter claims to themselves actually benefits them in 2 ways, because the 85% rule also incentivizes maximizing both premium collected and payments distributed to increase total profits in the same way as a cost-plus contract. And when the patients they insure are afraid of claim denials and being stuck with an enormous bill, they are even more likely to choose healthcare providers directly owned and suggested to them by UNH
CFAFL | 8 hours ago
This is exactly it! They are ensuring they approve claims-- as many as they can that will filter the money right back to them.
Boneraventura | 10 hours ago
Providers or insurance companies? You got it mixed up
solidlyproper | 9 hours ago
Free Luigi
SanshaXII | 10 hours ago
Why is he the only one?
2Hanks | 12 hours ago
I keep getting this commercial that I hear. It’s for United Healthcare and part of the commercial is a supposed United employee saying “everyone matters”.
bak3donh1gh | 8 hours ago
But some people matter more. That's the subtext. Everyone matters, sure. But some of you don't matter as much as others.
LiterallyEmily | 6 hours ago
> “every[ ]one [of our shareholders' profits] matters [more than your lives]”
gotta read between the lines properly
CoderDevo | 12 hours ago
They are asserting that a third of all claims are fraudulent, whether negligent or willful.
A THIRD?!? With this volume, they are asserting that a third of the country are willing to commit fraud.
There is no rational explanation for this except that UnitedHealthcare themselves are the ones committing fraud in their polices where they state what they cover.
pfannkuchen89 | 12 hours ago
Well, you see, it makes more sense when you realize that for profit health insurance companies view having to pay for healthcare as a preventable loss in income. Labeling as much as you can ‘fraud’ just makes it easier to make money.
Final-Carry2090 | 6 hours ago
Even the 16% denial by other insurance companies is unacceptable. This person that essentially spent half their life learning to provide care recommended x treatment and the insurance company knows better based off of their vague third party understanding?
BalanceJazzlike5116 | 6 hours ago
Many doctors commit insurance fraud doing medically unnecessary procedures and tests for profit. Unfortunately there are no good guys in this system; doctors, hospitals, pharmaceutical companies, and insurance companies are all fighting to extract as much as they can from the consumer….I mean patient.
RipComfortable7989 | 6 hours ago
Source on that? Sounds interesting that your logic is "there exists some fraud" therefore "1/3rd rejection of claims is fine".
BalanceJazzlike5116 | 3 hours ago
Not what I said. I love how you put shit in quotes I didn’t say. Fucking ridiculous
Final-Carry2090 | 6 hours ago
Wild claim since most doctors are salaried not commissioned.
BalanceJazzlike5116 | 3 hours ago
Many doctors own their own businesses and do stuff like this
https://www.justice.gov/opa/pr/doctor-sentenced-seven-years-prison-24m-medicare-fraud
https://www.justice.gov/archives/opa/pr/doctor-sentenced-54m-medicare-fraud-scheme
https://oig.hhs.gov/fraud/enforcement/los-angeles-physician-indicted-in-33-million-medicare-fraud-scheme/
There are countless examples of this. Open your eyes
Final-Carry2090 | 3 hours ago
“Most”
BalanceJazzlike5116 | 2 hours ago
You can’t see the forest through the trees can you?
Final-Carry2090 | 2 hours ago
You’re literally missing the forest for the trees with your singular stories, stupid.
300 to 400 prosecutions a year for medical fraud. We have over a million registered doctors.
0.04% denial rate would be reasonable off of those numbers. We’re sitting at 16% average not just thanks to crooked companies but idiots like you.
BalanceJazzlike5116 | an hour ago
lol the people caught are the tip of the iceberg. How many people don’t report their cash tips as income? How many are prosecuted for it? You can’t be naive enough to think all the convictions are the only cases of fraud
Final-Carry2090 | an hour ago
Yeah, fuck off to Russia with that guilty until proven innocent crap.
CoderDevo | 4 hours ago
Fraud exists anywhere money is transacted, but not at these rates unless the regulators are themselves corrupt.
BalanceJazzlike5116 | 3 hours ago
What rates? And yes regulators, medicL state advisory boards are typically corrupt/in bed with the industry
CoderDevo | 2 hours ago
33%. It was in OP's headline.
BalanceJazzlike5116 | 2 hours ago
Why are you replying to me? My point was doctors commit fraud I made no mention of the percentage claims that are fraudulent because that data isn’t out there and obviously you can only count the ones caught.
CoderDevo | 56 minutes ago
I replied because you are on my thread and asked me a question.
BalanceJazzlike5116 | 34 minutes ago
I was responding to the preceding comment and then you chimed in. My point to him was fraud exists so you can’t have a 100% approval rate. Have no idea what the optimal rate is but it ain’t 66% nor is it 100%
CoderDevo | 33 minutes ago
They didn't say 100%, either. This whole thread is people agreeing with each other.
InterestingSpeaker | 11 hours ago
It doesnt mean a third of the country is willing to commit fraud. Some people willing to commit fraud can submit many fraudulent claims. Its entirely plausible. I dont know though whether the claims they reject are fradulent
Turtledonuts | 9 hours ago
That would require that they are constantly flooded with millions of fraudulent claims for procedures who are somehow adding 30% to the total volume of healthcare claims in the country. That's absurd.
EtherBoo | 5 hours ago
It's not just fraudulent claims, it's claims that are not in line with the policy, usually for services that aren't covered.
For example, I broke my wrist in 2020 and my insurance stopped covering OT after 30 visits because that was the policy limit for that injury. They were able to hide behind medical necessity because their metrics show 30 visits is sufficient for any injury.
Now the whole thing was bullshit, and I lost function in that wrist, I don't have full ROM in that wrist now and I'll never be able to regain it because the recovery window is closed, but that was their out.
A common one today is physicians attempting to prescribe Ozempic for weight loss. A lot of times the doctor will tell the patient they don't think it will be covered, but they can try and see if it will and it usually gets denied unless it's associated with a diabetes diagnosis.
TedMich23 | 11 hours ago
Supremely Evil Consulting firm McKinsey & Company has recommended all insurance companies deny 40-50% of all claims because it spikes profits.
Allstate was the 1st to do this and all others are rushing to copy. Why provide services when stealing is so much more lucrative?
BooRadley136 | 11 hours ago
Healthcare insurance companies legally can't deny that many claims, they have to pay out 85% of the money they take in
bak3donh1gh | 8 hours ago
I love how people keep saying this as something that absolves everything that the insurance industry is all obviously doing. that there's no way that it could ever be circumvented.
You have a convicted felon pardoning people for massive drug offenses and, in all likelihood, a pedophilia ring that he himself ran, in the coming months. You think that health insurance companies can't get around this little issue?
Hey, PFAS is allowed to be discharged into your water again soon. Sewage in your drinking water? A-okay.
possiblyMaybeAnother | 10 hours ago
Legally, all drivers have to drive at or below the speed limit
jasonbuz | 9 hours ago
CMS doesn’t audit your driving history, but they do audit most health insurers to ensure this law is being met.
Xperimentx90 | 9 hours ago
Drivers aren't sending reports of their car's speedometer, odometer, and gas receipts to state and federal governments
Turtledonuts | 9 hours ago
As we all know, healthcare insurance companies are good corporate citizens who love following the law and want to help people. They absolutely pay out their required 85% because they know that there would be harsh consequences for not doing so.
Gil_Demoono | 6 hours ago
Consulting is such a fucking scam. No shit spending less of your money will increase fucking profits you fucking dweeb.
And what happens after an insurance company does reject 40% of claims and post record profits? They have to post record profits again next year and the advice will be to add a few percent to that number again.
The genuine ceiling to this is finding the point at which the denial percentage causes a cultural shift in Americans that make them believe it is simply better to go without insurance.
Snlxdd | 12 hours ago
Lot of good info, but they really do nothing to back up their thesis claim here and it kinda bugs me.
So they denied 33%, was that a record high? a record low? Average? Why not show claim denial rates from other years?
As for the record highs, they’ve hit record high stock prices pretty much every year before 2023 too. Why is 2023 interesting or unique.
Impossible-Pin5051 | 11 hours ago
Claim denial rate isn’t even what you really care about. Is it the case that they deny claims to seek profit? There’s federal mandates on spending >85% of premiums on health care, they can’t just pocket the money. People just want a scapegoat, the system is unhealthy but it’s a combination of manufactured scarcity, bad pricing incentives, and grifting govt money that got us here, not just greedy insurance companies
harrytrumanprimate | 9 hours ago
The 85% is technically true but hides the fact that they have vertical integration within pharmacies and doctors. For example, the same company owns your doctor, insurance, pharmacy, etc. So you go to the doctor, your procedure would have normally cost $1000. Insurance pays $900, so it looks like 90% MLR. In reality that $900 is paying their other company, which they own and get to keep the profits of. The cost of care going up increases their premiums paid, but they are really paying themselves. The whole thing is a bad faith loophole.
Impossible-Pin5051 | 2 hours ago
Agreed on bad faith loop, but I’m saying bad incentives aren’t only within the insurance companies. In other words, I think the problem is more complicated than “evil insurance company” where “get mad at insurance company” will lead to “regulation against insurance companies” and that will lead to lower prices for people. I think the quality of care Americans get is really bad for what they pay for, and we need to intervene on scarcity at the supply level to make meaningful improvements
harrytrumanprimate | 2 hours ago
healthcare and large systems like it are deeply complex and have multi-faceted problems which will also require multi-faceted solutions. Discourse around them tends to be "okay, but X is also a problem, and Y solution doesn't solve for X", but also losing sight into the fact that X doesn't solve for Y. Yes - there are scarcity problems that should be addressed. Yes - the MLR loophole is ridiculous and there should be some trust-busting of big firms being able to get around it. There are a lot of different regulations that should likely happen, investments into education, investments into better QOL for healthcare professionals to attract more talent, etc. All will need to happen. I'm glad it's not my job to solve it
Turtledonuts | 9 hours ago
> There’s federal mandates on spending >85% of premiums on health care, they can’t just pocket the money
They kinda can though, there's basically no punishment or consequences for their crimes. Insurance companies are out here automatically denying claims from doctors asking for routine procedures to deal with known issues for patients. Every healthcare worker in the country will tell you that getting insurance to pay for healthcare is one of the largest barriers to healthcare around.
bak3donh1gh | 8 hours ago
You're ignoring that they are at times the one that these claims get paid out to. So they can deny you if you're going to use some other service that doesn't include their sister companies. And then when you go to their sister company, they can artificially inflate how much they're going to charge you because they're paying themselves.
if there are hands and feet above the industry standard, that is indicative of a problem. How do you not see that that's not something that should be looked into and And is it an obvious litmus of how horrible they are?
Keep sucking that insurance cock, right? They'll one day give you that explosive ending that you love so much.
Impossible-Pin5051 | 2 hours ago
We can have more than one problem, and being angrier and more insulting about it won’t lead to better outcomes. Americans have bad healthcare outcomes for what they pay for, the fact that there are multiple reasons underlying this beyond mustache twirling executives doesn’t mean I’m even a fan of them. You’re just angry and unable to reason about the system more than meme-able quips
Rodot | 7 hours ago
They can absolutely pocket the money if they own healthcare subsidiaries that they preferentially pay claims to over external healthcare facilities. Which they do.
Ch1Guy | 12 hours ago
UnitedHealth Group (UNH) hit its record high for the 2022 calendar year on October 31, 2022, closing at $552.05
UnitedHealth Group (UNH) hit its record high for the 2023 closing at $557.68 on December 1, 2023.
The stock managed to peak about 1% over its 2022 price.
RagingAnemone | 12 hours ago
They also had a Net Income of $22B with a dividend payout of $6.7B
dancergirl777 | 11 hours ago
My Mom had side effects from radiation treatment post surgery and treatment for cancer. UnitedHealthcare was the only insurance company that wouldn’t cover her medication. That company is the worst.
HaroldKid | 12 hours ago
We really need successful claim appeals to result in massive financial penalties for Healthcare companies.
"A separate federal lawsuit alleges the algorithm [that controlled claim denials] had a known 90 percent error rate."
This is egregiously immoral.
Botasoda102 | 12 hours ago
A bit of context. Most denials are just, “we aren’t going to pay this based upon a few codes on a claim firm without looking at medical records.” Once records are submitted, most claims are paid. Believe it or not, too many healthcare providers cheat.
That’s not to say insurers are blameless in a mess Congress hasn’t adequately addressed in 60 years.
Geodude532 | 7 hours ago
I've had stuff kicked back 3 times because the insurance company didn't bother to check that the one requirement, X-rays, was already done. Multiple doctors have said that it's very common that they have to just resubmit multiple times without changing anything.
OnceMoreAndAgain | 10 hours ago
The average person isn't aware the extent of fraud that is done by doctors across the country every day. Doctors, understandably, have a good reputation, but some of them are extremely greedy people who exploit the flaws in the healthcare system.
A common way doctors commit fraud is by performing unnecessary procedures or by intentionally submitting incorrect procedure codes that are more expensive. The patient is never going to know that wrongdoing was done, because they trust their doctor and they wouldn't be able to notice well hidden fraud like that. It's really the insurance companies that have to try to police this, because who else will?
I work in this industry as a data analyst and have personally done reviews of this type of fraud and it was eye opening to say the least... That said, this fraud is not a major reason why healthcare costs are so high. Fraud is just silently a major issue that all types of insurers have to deal with and healthcare insurance is no exception.
Turtledonuts | 9 hours ago
> It's really the insurance companies that have to try to police this, because who else will?
Medical boards and independent regulatory agencies, ideally. Evaluating the necessity of procedures should be done by an independent third party of medical professionals qualified to evaluate the cases. The insurance company has a financial incentive to label things as fraud and punish doctors for seeking more expensive procedures. You don't hire a random guy to check if your house is up to code, you hire a licensed professional. Healthcare fraud investigation should be carried out by licensed medical professionals who can actually evaluate the facts of a case.
sai-kiran | 8 hours ago
Explain this to me: What is the point of visiting a “network” provider, if the insurance provider isn’t confident that the doctor wouldn’t commit fraud? What are they fucking vetting then?
2FistsInMyBHole | 11 hours ago
The 33% denial rate is specifically for ACA Marketplace Plans. Their denial rate across all plans in 10% (including the 33% for ACA Marketplace plans.)
sevenw1nters | 10 hours ago
I went on their website and found a nurse practitioner at a CVS MinuteClinic near me. Went to see her had a physical nothing crazy some refills some bloodwork took 20 minutes. A month later i got a $700 bill in the mail because it was "out of network" despite me finding it on their website. I called CVS and asked if they would bill me the cash price and they said they can't because they have a contract with UnitedHealthCare despite me being out of network. I appealed the claim and they took 3 months to review it but eventually denied it. By that time CVS sold it to a debt collector I ended up paying them. It would have been much cheaper if I just had no insurance at all which now I don't.
SynapticStatic | 10 hours ago
For profit healthcare should be illegal. Such a fucking bullshit system.
Remember when they complained about "Death panels" when the ACA was getting put into legislation? Yea, I remember. Here's your fucking death panels.
MightyBone | 12 hours ago
Nothingburger.
Healthcare needs massive reform in this country, but United spends about the same (MLR - Medical Loss Ratio) as other healthcare companies. By law companies have to spend at least 85% of their premiums on medical care and can't pocket any excess profits, so there is no incentive for them to reject more claims and they aren't even reaching the 85% mark as they are at 89% right now.
This is more likely a function of the fact United offers a wider range of bronze level plans and is more active in the ACA reporting areas used on data like this. And because they offer a larger variety and more heavily target bronze level markets, they obvious get higher rates of denial due to the obvious fact the more bronze plans you offer the higher your rejection rate will be as a portion of your total offering portfolio.
geraffes-are-so-dumb | 12 hours ago
That threshold only applies to large group plans. Self-funded employer-sponsored plans, which is how 2/3s of all workers in the US are covered, aren't subject to MLR rules at all. On top of that, individual and small group markets only have to hit 80%.
And insurers that have bought up hospital systems, doctor practices, and pharmacies can pay their own subsidiaries inflated prices, count that as “medical spending” to satisfy the ratio on paper, and keep the profit inside the corporate family.
Stayvein | 11 hours ago
I wish they would have at least alluded to the inflationary pressure providers contribute to claims costs. Many insurance contracts just shave a percent off of what is charged, which is pressured by the provider’s own investors.
Look at all the private equity invested in health care.
Xabster2 | 11 hours ago
Pointing out of a single "worse" insurance company really misses the point of why the system is so broken. It's not due to individual insurance companies being a little bad or pushing the limits of what they can deny. It's way more systemic.
Ironic_Papaya | 7 hours ago
I still don’t understand why the US health Insurance industry isn’t the biggest and most illegal conflict of interest ever. How can a company that has a financial gain from denying claims be trusted to decide medical necessity.
Straight-Ad6926 | 6 hours ago
It's not a conflict of interest if the system is doing exactly what it was designed to do which is extract premiums and hoard the cash. The health part was just a marketing gimmick and still will be.
Gloomy_Yoghurt_2836 | 7 hours ago
Its good business practice by United. Its job is to make a profit and a solid return for investors. Providing care is secondary tonthe function of insurance. And why we need universal single payer. Health care should not be a profit based activity.
Impossible_Break698 | 12 hours ago
I had a botched double jaw surgery with the only in network doctor within a 100 mile radius. It has completely ruined my life, and I have been consumed with trying to fix what they broke. Currently over $100,000 down and on my 3rd jaw surgery. Suffice to say, I celebrate Luigi.
Lumpy_Pianist595 | 11 hours ago
The surgeon did a bad job so somebody else deserved to die?
Special_Order-937 | 9 hours ago
I’m going to parse this and infer that their insurance forced them to a surgeon with a less than stellar rating whereas a better surgeon may have avoided this outcome.
Lumpy_Pianist595 | 7 hours ago
We can come up with dozens of hypothetical explanations.
My house is damaged in a hurricane and homeowners insurance will pay for a new roof. If roofer does a bad job should the insurance CEO die?
Impossible_Break698 | 4 hours ago
Let me fix your analogy up a little. The roofer is wildly unqualified because that is all the insurance will pay for. The homeowner's roof collapses a week later and insurance refuses to pay for anything.
Odd how you show so much empathy for a health insurance CEO, but none for my situation. When you have a family member rot away from cancer that could have been prevented had insurance not drug their feet on treatment, maybe you will have a change of heart.
Lumpy_Pianist595 | 2 hours ago
There's no empathy for the CEO, it is lack of empathy for you. From your perspective, it is okay to murder said CEO. I do not share that point of view. I can understand that your situation sucks and I still do not think that justifies killing another human.
Impossible_Break698 | an hour ago
Idk how you can read all these comments talking about UHC's actions that caused life altering consequences to millions of people and not be able to see why anyone would celebrate the CEO's murder.
I celebrate the CEO's murder the same way millions of people celebrated Ted Bundy frying. I view them one in the same as any sane person would.
UHC forced me into a surgery with a widly unqualified surgeon and it has completely ruined my life. I'm glad he is worm food. May he rot.
Impossible_Break698 | 4 hours ago
That's exactly what happened, yes. My insurance only covered a teaching hospital.
turbopig19 | 9 hours ago
[ Removed by Reddit ]
whooptheretis | 7 hours ago
> Suffice to say, I celebrate Luigi.
Hasn't he maintained his innocence? He hasn't been found guilty, why are you assuming he is?
Impossible_Break698 | an hour ago
Are they going to use our reddit comments against Luigi in his trial?
whooptheretis | an hour ago
No, why do you ask?
Memitim | 12 hours ago
Look on the bright side: you may never be sure exactly what you're paying for when you trying to cover your health, but the insurance company will always get the full premium regardless, so you don't have to worry about them losing money.
Special_Order-937 | 9 hours ago
I live in Australia where I don’t have to put up with this.
I also live in Sri Lanka where I also don’t have to put up with this.
The fact that US healthcare bureaucracy and politics are now much worse than Sri Lanka is a big worry.
Fabulously-humble | 8 hours ago
Pay premiums while you are heathy.
When you get sick deny effective (expensive?) care.
Unprofitable customer dies faster.
Profit. This is capitalism. It IS THE DUTY OF THE CEO.
This is for profit healthcare. Don't try to fool yourself. Canada is better. The UK is better. Norway is better. Mexico is better.
Are they perfect? No way. But in the US is is the WORST OF ALL POSSIBLE OUTCOMES. It is expensive and ineffective.
TraditionalLaw7763 | 11 hours ago
Why dont people boycott this shithole company? Even at my crappy job, I got to choose providers and I definitely didn’t even think twice about my “hell naw” when I saw them on the list.
shchshchshch | 11 hours ago
The sad thing is, everyone who is invests in high-cap or total-market index funds—which is to say, pretty much everyone who invests—probably owns a piece of United Healthcare.
possiblyMaybeAnother | 10 hours ago
Have you seen their latest ad campaign? It has UHC "employees" talking about how great it feels to help people navigate the health care system. Says about all you need to know about UHC.
waigl | 8 hours ago
Question: Why do people still go to UnitedHealthcare for health insurance after all this? Feels like throwing premium money out the window for nothing…
Blackstar1401 | 6 hours ago
Employers pick your healthcare.
Zestyclose-Jacket568 | 6 hours ago
It is like when you have company that focusem on profit then it wants to increase the profit. In this case by cutting costs - people claims.
That is why civilised countries have public healthcare that is not focusem on generating revenue.
illonlyfadeaway | 6 hours ago
Those are rookie numbers! The top five home insurers denied almost 50% of all claims.
Keep paying your mandatory insurance health, auto, and home insurance premiums.
inscrutablemike | 11 hours ago
They have an obligation to weed out overbilling, unnecessary procedures, and outright fraud. What do you think they should do instead? They're not an infinite money machine.
Legitimate_Page659 | 8 hours ago
Strange how the rest of the industry has significantly lower rates of overbilling, unnecessary procedures, and outright fraud.
That must be it. It couldn’t possibly be that UHC intentionally denies valid claims as part of their business model knowing that many won’t bother to appeal.
Nope, they’re the one honest insurance company!
CFAFL | 8 hours ago
They seen to be an infinite money machine for the investors and CEOs.
YoungRichBastard26s | 11 hours ago
Reason why they was saying rip to they ceo insurance companies shouldn’t be allowed to be on the stock market they put investors and stock interest before customers who the the reason they making money
cjscholten81 | 9 hours ago
That's why in the Netherlands, health insurance companies cannot be for-profit. That means no profit payouts to management or shareholders. Profit must be kept in the organization.
exploringspace_ | 7 hours ago
The US “free market” healthcare is more like being walked into the mob’s overpriced grocery store with a gun to your head, being told it would be a shame if you didn’t like anything you see. You can’t really get the capitalistic benefits of a competitive marketplace from products when the alternative is a game of Russian Roulette.
_Mamushi_ | 12 hours ago
Absolutely sickening that people pay so much into healthcare only to be denied for the sake of profits. The entire system is the biggest scam ever
Open_Pollution_8038 | 12 hours ago
The flip side to not denying claims is fraud and abuse.
How many times have you run into a doctor that pushed unnecessary labs and procedures?
I’ve had it happen so many times now that I’m pessimistic about the medical profession. They should be required to disclose their financial relationships to drugmakers when recommending drugs.
PufferfishLove | 12 hours ago
I have never had this happen. I have, however, had countless legitimate claims denied by UHC.
Gamplato | 12 hours ago
What’s your definition of “legitimate”? Sounds a lot like one you’ve made up.
Alone_Step_6304 | 12 hours ago
Certified Misdirection moment
cittadinosopradi | 12 hours ago
It is a bit of a misdirection but also overall a valid claim. Healthcare is rife with fraud + abuse driven by rent-seeking behavior and incentives that are misaligned with patient outcomes
Alone_Step_6304 | 12 hours ago
Yes, but generally not through unnecessary testing as initiated by providers. The providers engaging in systematic unnecessary testing are generally very new/poor mid-level clinicians not comfortable in their own decision-making, actual quack noctors/chiropractors and "functional medicine doctors", etc - Practicing physicians as a group of people do not generally over-order
Also calling bullshit and asking to substantiate on nebulous kickbacks and asking them to bring more than just, "Yeah I bet they're getting paid somehow! (?) to give their patients the medications needed to address their specific disease processes"
Open_Pollution_8038 | 12 hours ago
Studies show that doctors who are paid speaking fees or consulting arrangements from drugmakers tend to push hard the drugs of those drugmakers.
It should be mandatory disclosure if you’re recommending a procedure performed by a company that you’re taking money from.
cittadinosopradi | 12 hours ago
Yeah my original comment should have been narrower. I was agreeing with only the first sentence of the other comment - I intentionally try not follow this sector closely anymore so can’t speak to those other claims
> The flip side to not denying claims is fraud and abuse.
churningaccount | 12 hours ago
They are not always strictly "unnecessary."
Often it's to cover all of their bases, since the US is a liability nightmare for physicians. Why not order a CT scan just in case, when the lack of ordering one could be used against you in a malpractice case? This is where single-payer systems win a bit in terms of efficiency, since the government-imposed rules on what procedures and tests are necessary and when are more consistent and strictly laid out.
And then sometimes the doctor will genuinely be ordering the most effective medication or procedure, but just without regards to its cost. Let's say that there is a newly patented cholesterol medication that is effective in 99% of the patient population, whereas the old generic one is only effective in 90% of the patient population. Well, as of today, it's up to the individual insurance companies to deny the new, expensive, medication unless the old one is tried first. Doctors themselves, however, have no incentive to do that cost comparison. If every patient on the generic medication was to be switched to the new, patented, one, then everyone's insurance premiums would rocket upwards, for only a marginal improvement in health outcomes overall.
Open_Pollution_8038 | 12 hours ago
Just look at the rate we perform hysterectomies in the US to any other G7 country (it’s almost 40% of all women by 60). Or c sections. It’s seen as a freebee in this country.
Turtledonuts | 9 hours ago
The Hysterectomy rate in the US is roughly 20%, not 40%, and has been falling for decades. The rate was higher in the 20th century due to gynecologic cancer being more common and harder to treat - smoking was a major driver of this.
https://doi.org/10.1016/j.ajog.2022.06.028
Open_Pollution_8038 | 6 hours ago
If you go back and reread my comment, you’ll note that I said by 60 almost 40% of women will have had a hysterectomy.
You then replied that’s false the overall rate is about 18%.
It is not false - on average 1 in 5 (roughly 18% as you quoted) women have had their uterus removed. By the time they reach 60 that number jumps to about 40%. By 70 it’s about 1 in 2.
Do you understand?
Here’s the source: https://pmc.ncbi.nlm.nih.gov/articles/PMC10643045/
Turtledonuts | 6 hours ago
if you read the study i linked, the conclusions specifically note that the overall percentage of woman in the US who have had a hysterectomy is 20%, and that the widely reported 40% number is incorrect.
Do you understand?
Open_Pollution_8038 | 6 hours ago
I didn’t say 40% of every woman has had their uterus removed, go reread my comment.
I said 40% of woman by 60.
R3luctant | 12 hours ago
I work in it at a hospital and the billing people constantly complain about how difficult united makes it to submit claims. It isn't a bug, it's a feature.
CryptographerIll3813 | 12 hours ago
Lmao you know how overworked most doctors and hospital staff are? Unnecessary labs and procedures give me a break. What a ridiculous anecdotal exaggeration
Open_Pollution_8038 | 12 hours ago
They’re also well compensated. Go look at the top 20 paying jobs and most are in medicine.
Special_Order-937 | 9 hours ago
I love being in Australia where we have much more freedom to request tests and investigations as indicated clinically as opposed to some accountant telling us what we can and can’t do for just about everything because of cost metrics.
Open_Pollution_8038 | 6 hours ago
In socialized medicine you still have an accountant telling a doctor what to do lol and it’s way worse because they also dictate exactly how much you get paid.
Single payer destroys medical professionals salaries and it’s why a McDonald’s manager in the US makes as much as a doctor in Japan.
Special_Order-937 | 5 hours ago
Not all of us are about stuffing as much money as we can in our pockets at the expense of the patients.
Turtledonuts | 9 hours ago
This is a minor issue compared to the much larger systemic issue of claims denial and intentionally byzantine healthcare plans. Oh, this doctor is out of network, oh that procedure didn't have prior authorization, oh we're changing what medicines we cover, etc.
Open_Pollution_8038 | 6 hours ago
The alternative is why socialize medicine but I highly doubt the medical industry really wants to see that happen lmao.
OzonjoPrime | 11 hours ago
Reddit keeps removing my comment for being "too short"...
"Luigi!" won't do. Neither will "Luigi Mangione!"
Let's try....
We need more people who think and act like...
Luigi Mangione!
and need him to be aquitted for all charges.
To be followed by the closure of all for-profit "health" insurance companies, and the establishment of single-payer universal coverage.