[HN Gopher] UnitedHealth hired a defamation law firm to go after...
___________________________________________________________________
UnitedHealth hired a defamation law firm to go after social media
posts criticiz
Author : taimurkazmi
Score : 205 points
Date : 2025-02-11 17:44 UTC (5 hours ago)
(HTM) web link (fortune.com)
(TXT) w3m dump (fortune.com)
| throw_a_grenade wrote:
| This is the "defend" part, right?
| zusammen wrote:
| It's almost adorable that these people still care about their
| reputations. These companies only exist because the state
| protects their racket. No one likes them and even conservatives
| in other countries cite the US healthcare system as something
| they do not want.
| sam0x17 wrote:
| This is their strategy to improve their public image??
| vkou wrote:
| Is their public image particularly relevant to their bottom
| line? It's a captured industry.
| jimt1234 wrote:
| I think their strategy was adopted by their new PR director,
| Barbra Streisand.
| fiftyfifty wrote:
| Why can't they just put this money towards rejecting fewer
| claims?
| dmm wrote:
| If they paid out 100% of their revenue, how many more claims
| would they be able to pay? By law they have to payout at least
| 80% of premiums as claims. Their profit margin is 5.5%.
| StormChaser_5 wrote:
| Depends what their costs are but if all claims would take
| 85.5 of their premiums with the rest their overhead costs
| then I think most of their customers would be happy
| franktankbank wrote:
| They bloat the overall health care system to increase the
| absolute value of that 80% premium. Efforts to human health
| are overburdened by exercises of human bureaucracy and
| frankly obviously intentional bad service.
| NewJazz wrote:
| We should up that threshold until these companies start
| posting consistent losses, then ease up.
|
| I tried researching this, but couldn't come up with an
| answer: if an insurance company pays doctors to review and
| dent claims, does that doctor salary count as "quality
| improvement activities", or administrative?
| throwway120385 wrote:
| Isn't profit what the board keeps after they pay for
| everything including the people in the board's employ? So in
| that sense the profit margin doesn't mean terribly much
| because you can always pay more to your senior managers and
| less to your patients.
| dmm wrote:
| The 80/20 rule[0] requires insurance companies to pay out
| at least 80% of premiums. That's revenue, not profit, and
| is independent of their costs.
|
| So if they were a charity which magically had 0 costs the
| most payouts could increase is 20%.
|
| Healthcare demand is infinite and providers have every
| incentive to inflate costs and recommend as many services
| as possible. I don't like our healthcare system but as it
| is, insurance companies play a necessary role of rationing
| care and there is no magical fix to claim denials.
|
| [0] https://www.healthcare.gov/health-care-law-
| protections/rate-...
| ceejayoz wrote:
| Plenty of that 80% goes to profit, through their
| extensive network of subsidiaries to capture both ends of
| the equation.
| https://news.ycombinator.com/item?id=43016192
| lotsofpulp wrote:
| You keep claiming managed care organizations are earning
| outsized profit margins, but the audited financials on
| their 10-Ks indicate otherwise, as do their subpar annual
| stock returns.
|
| You can either accept that these business do not have a
| lot of pricing power, and they compete on razor thin
| profit margins (except UNH, but that is because they sell
| software and healthcare, not just insurance). Even then,
| their profit margin is only 5% or so, which is
| objectively a low profit margins.
|
| Or you think there is a massive fraud and a nationwide
| conspiracy amongst 7 publicly listed businesses
| (UNH/Elevance/Cigna/CVS/Humana/Centene/Molina), and
| numerous non profits like Kaiser Permanente and various
| BCBS affiliated plans (because their premiums are
| basically the same as the for profit insurers).
|
| The easiest thing to do though, is ask yourself why
| shareholders would accept lower annual returns if their
| business they own earns so much money?
|
| Put their stock tickers in here:
|
| https://dqydj.com/stock-return-calculator/
|
| https://dqydj.com/sp-500-return-calculator/
|
| You would think they could do better than SP500 if they
| were raking it in. Although, UNH did do better, but that
| is because they sell more high margin stuff like software
| and healthcare.
| ceejayoz wrote:
| > You can either accept that these business do not have a
| lot of pricing power...
|
| I definitely do not accept that assertion. Especially for
| the big vertically integrated ones like UHC.
|
| > Or you think there is a massive fraud and a nationwide
| conspiracy amongst 7 publicly listed businesses
| (UNH/Elevance/Cigna/CVS/Humana/Centene/Molina), and
| numerous non profits like Kaiser Permanente and various
| BCBS affiliated plans (because their premiums are
| basically the same as the for profit insurers).
|
| Yes? It's a cartel.
|
| "Massive fraud" isn't really even in dispute!
| https://www.nytimes.com/2022/10/08/upshot/medicare-
| advantage...
|
| > Even then, their profit margin is only 5% or so, which
| is objectively a low profit margins.
|
| Walmart's is lower than that.
|
| > The easiest thing to do though, is ask yourself why
| shareholders would accept lower annual returns if their
| business they own earns so much money?
|
| That's why they do stock buybacks.
|
| > You would think they could do better than SP500 if they
| were raking it in.
|
| If everyone else wasn't also enshittifying at the same
| time, sure.
| lotsofpulp wrote:
| > "Massive fraud" isn't really even in dispute!
|
| Good article, and they definitely do skate on the line,
| but there aren't any indictments and it doesn't seem
| there is any evidence they are colluding. Just lack of
| enforcement by the feds means it pays off for everyone to
| break the rules, but even then, the business is not
| profiting much.
|
| >Walmart's is lower than that
|
| So? That doesn't mean 5% is a low profit margin. And the
| other MCOs are at 3% or less.
|
| > That's why they do stock buybacks.
|
| The effects of stock buybacks are incorporated into the
| total return calculation, so not sure what the relevance
| of this is either.
|
| I just don't see the logical consistency of claiming a
| business is doing super shady things to earn ridiculous
| amounts of profit, and then the business not doing better
| than SP500.
|
| Or why insurance premiums at all the non profits would
| similar to premiums at all the for profits.
|
| The more likely and simple answer is that it's a
| cutthroat business, where almost all revenue goes out as
| expenses, and that is why all the premiums are similar,
| because no one can really cut more costs than they
| already are.
| jncfhnb wrote:
| Profit goes to shareholders, not the board. The board is
| generally supposed to want more money to shareholders, not
| internal management. The incentives here are not great
| though, as being a board member is generally a cushy role
| for which one does not want to rock the boat.
|
| However senior management generally wants to pump the stock
| price to get comp, not juice their salary. And to pump the
| stock price, they want money going to shareholders (or
| growth).
| philipov wrote:
| > _And to pump the stock price, they want money going to
| shareholders (or growth)._
|
| Paying out dividends hasn't been a major factor in stock
| picking logic for at least 20 years, and rather than real
| growth, they'd rather pad their numbers by firing people.
| Shareholders get their money by buying low and selling
| high, not through something as quaint as long-term
| investment.
|
| https://www.youtube.com/watch?v=-653Z1val8s
| ceejayoz wrote:
| > Their profit margin is 5.5%.
|
| Sure, except they own the pharmacy
| (https://en.wikipedia.org/wiki/Optum), the payments solution
| (https://en.wikipedia.org/wiki/Change_Healthcare), the
| outpatient surgery centers
| (https://en.wikipedia.org/wiki/SCA_Health), the in-home care
| providers (https://en.wikipedia.org/wiki/Amedisys), and a
| whopping 10% of the country's doctors - the nation's single
| largest employer of them
| (https://www.statnews.com/2024/07/25/united-health-group-
| medi...).
|
| (Oh, and they pay their doctors higher rates.
| https://www.statnews.com/2024/11/25/unitedhealth-higher-
| paym...)
|
| Those are "expenses" for that margin calculation.
| JumpCrisscross wrote:
| > _Those are "expenses" for that margin calculation_
|
| Source? They would be expenses for the insurance sub but
| profits for the consolidated public company. The latter are
| 22% (gross) and 4% (net).
|
| I don't have a horse in this race. But it seems like the
| problem is at the level of PBMs and providers more than
| insurers.
| ceejayoz wrote:
| > They would be expenses for the insurance sub...
|
| Yes, and that's the subsidiary that has the 80/20
| expenses rule.
|
| UHC ensures as much of the 80% paid for "patient care"
| winds up in their other subsidiaries that _don 't_ have a
| profit cap.
|
| > But it seems like the problem is at the level of PBMs
| and providers more than insurers.
|
| UHC is both the insurer _and_ the PBM, and they 're
| buying up all the providers they can get their hands on.
| JumpCrisscross wrote:
| But we can see the group profits. They're right at 20
| gross and much lower net. You're arguing they're double
| booking profits; that should show more profits. There
| aren't more profits.
|
| Also, other comments _praise_ Kaiser for being more
| consolidated. Is your argument care at Kaiser is much
| worse?
| ceejayoz wrote:
| Let's say I'm legally required to use 80% of my salary on
| cupcakes. My wife makes a cupcake, and I purchase it for
| $100k. Do we think this was the likely intended result of
| the legislation?
| JumpCrisscross wrote:
| You're using hypotheticals when we have actual numbers.
| (And more-consolidated competitors with higher customer
| satisfaction rates.)
|
| You have a solid hypothesis. The cross ownership exists.
| But the hypothesised effect--margin expansion--isn't
| observed. The best we can say is they tried to juice
| margins but failed to, which is neither here nor there,
| and pins administrative incompetence--not greed--as the
| culprit.
| wahnfrieden wrote:
| https://fortune.com/2025/01/15/ftc-pbms-unitedhealth-
| brian-t...
| s1artibartfast wrote:
| I think comparison to Kaiser is very telling on the pros
| and cons. I have options for united and Kaiser at work.
| Kaiser is slightly cheaper but comes with major pros and
| cons. Cons are major internal gatekeeping for drugs and
| procedures. Pros are no getting stuck between provider
| insurer billing disputes, and most of your data under one
| roof.
|
| Kaiser works well for people willing to fight their
| doctors to get the care they want.
|
| United works well for people willing to fight their
| insurance billing department. It also works for people
| planning to hit their maximum annual out of pocket limit.
| xenadu02 wrote:
| You two are arguing across each other.
|
| JumpCrisscross is saying ignore the 80/20 rule for the
| insurance side. If you look at UHC's overall parent
| company profits - the profits _after_ they 've calculated
| in the profit from the supplier side like pharmacy
| benefit company, pharmacy, doctors, et al - it is 22%
| gross, 4% net.
|
| In other words the double-dealing only got them 4% net
| profit.
|
| For my part I think a lot of the extra money is
| disappearing into administration. Every doctor's office
| of any size employs extra staff just to deal with
| insurance company nonsense. Insurance companies employ
| extra staff to deny claims and fight providers. That
| extra staff justifies more layers of middle management.
| This repeats across all specialists and disciplines. Your
| radiology company? Extra staff to deal with insurance.
| Lots of people employed to shuffle papers and manage
| workers.
| gruez wrote:
| I don't see how those facts meaningfully changes the
| conclusion when the margin for the entire group, which
| includes the subsidiaries you mentioned was 3.6% last year
| and 6.1% the year before.
|
| https://www.unitedhealthgroup.com/content/dam/UHG/PDF/inves
| t...
| darth_avocado wrote:
| If they deny less claims, they'll need fewer adjusters, admin
| and customer care staff. They will still have 5.5% profit
| margins but the CEO will get paid less because the net profit
| won't perpetually grow and Wall Street doesn't like that.
| dmm wrote:
| I do not like our healthcare system and would
| enthusiastically support reform. But your arguments really
| don't make sense.
|
| The UHC CEO made 10M, even if we 10x that to 100M then if
| the CEO decided to give it all back, UHC could payout << 1%
| more claims.
| nradov wrote:
| If they deny fewer claims then medical expenses will rise
| for their self funded employer customers, and then those
| customers will switch their health plans to a competitor
| like Cigna or Aetna. Most coverage rules are driven by
| large employers. UHC would be happy to offer a health plan
| which paid every single claim if that's what employers
| wanted: it would actually mean higher profits for UHC.
| johnduhart wrote:
| > Their profit margin is 5.5%.
|
| 5.5% of what, dmm?
|
| https://www.healthcaredive.com/news/unitedhealth-
| unh-2024-re...
|
| > the Minnesota healthcare behemoth reported adjusted profit
| of $25.7 billion -- an all-time record.
| skyyler wrote:
| Is there any legal way to remove the leeches from the
| system?
|
| Obviously murdering healthcare CEOs and shareholders isn't
| legal, and I wouldn't endorse that method.
|
| Are there alternatives?
| vkou wrote:
| Yes, the legal way is to change the laws.
|
| Unfortunately that is rolling a boulder uphill, and even
| if you fire all of Congress (on this issue, you'd need to
| get rid of all the Republicans and at least a third of
| the Democrats) and replace it with people who give a
| crap, all it takes is one executive to stop enforcing the
| rules.
| JumpCrisscross wrote:
| > _you 'd need to get rid of all the Republicans and at
| least a third of the Democrats_
|
| And then most voters: "71% of U.S. adults consider the
| quality of healthcare they receive to be excellent or
| good, and 65% say the same of their own coverage. There
| has been little deviation in these readings since 2001"
| [1].
|
| [1] https://news.gallup.com/poll/654044/view-healthcare-
| quality-...
| skyyler wrote:
| "19% -- say they are satisfied with its cost"
|
| From your link.
| ceejayoz wrote:
| Quality of healthcare and quality of _insurance
| experience_ are not the same statistic.
|
| I'm very satisfied with my healthcare. I am not satisfied
| with my insurer.
| JumpCrisscross wrote:
| > _Quality of healthcare and quality of insurance
| experience are not the same statistic_
|
| The question was specifically about "the quality of
| healthcare you receive/your healthcare coverage."
| Coverage doesn't cover the insurer on cost, but it does
| on claims denials.
|
| Most Americans like their coverage. If you want to reform
| the system, you have to start with that fact and convince
| them they aren't risking what they have unnecessarily.
| ceejayoz wrote:
| > the quality of healthcare you receive/your healthcare
| coverage
|
| But that's two different things.
|
| If you put me in a giant mansion with a $100k/month
| mortgage, I will be quite satisified with my _house_.
| Very briefly.
| skyyler wrote:
| >Most Americans like their coverage
|
| Even more Americans (81%!) are unhappy with the cost of
| their coverage.
| JumpCrisscross wrote:
| Sure. We want the same system but cheaper. That's an
| important difference for someone advocating to scrap the
| system to make it cheaper. We want those lower costs. But
| loss aversion marries us to the good enough.
| skyyler wrote:
| The same system but cheaper is not the same system. There
| are leeches that need to be removed from the system.
| nradov wrote:
| A large fraction of UHG profits come from their Optum
| subsidiary selling software to other payer and provider
| organizations. This is separate from the health insurance
| business. If broken out separately they would be one of the
| 20 largest US tech companies.
| 7952 wrote:
| Surely the entire point of insurance is that the provider
| takes the financial risk. That is what they have been paid to
| do. If they cannot afford to do that through premiums then
| they should make a loss.
| nradov wrote:
| Most commercial health insurers no longer bear much
| financial risk. Instead they primarily administer health
| plans on behalf of large self-funded employers. Actual
| insurance is mostly limited to individual and small group
| plans, which are a much smaller line of business.
| lotsofpulp wrote:
| Some numbers here:
|
| https://www.kff.org/report-
| section/ehbs-2023-section-10-plan...
|
| While everyone calls them "health insurers", the industry
| term is "managed care organizations" (MCOs), which sell a
| variety of services, which may or may not include
| healthcare, managed care, insurance, negotiated pricing,
| and even retail pharmacy services.
| sega_sai wrote:
| The company's goal is to satisfy share-holders, not some pesky
| sick people.
| wesselbindt wrote:
| I don't understand, why would they do that?
| hypothesis wrote:
| For same reason any other insurance company doing it? Those
| guys are statistically the worst, with no one else being
| close.
|
| Like if your argument being fiduciary duty to rob everyone
| blind health outcomes be damned, then why say Kaiser is not
| being sued in to the ground?
| bobthepanda wrote:
| This i think depends on where you are with Kaiser; i know
| folks in Washington have bad times with them.
| SpicyLemonZest wrote:
| Kaiser doctors, because they're employees of the same
| organization that provides the insurance, are much less
| likely to prescribe treatments that will be denied. Which I
| like, don't get me wrong, but it's a double-edged sword.
| Many people with complex or hard-to-treat conditions feel
| that Kaiser isn't an option for them, because when they
| need some rare treatment another insurance company might
| fight you over, Kaiser simply won't prescribe it at all.
| coloneltcb wrote:
| My wife is on Kaiser, she was having extreme, persistent
| back pain. Before she could even talk a specialist, they
| told her she needed to attend a live webinar about back
| pain that was scheduled for 3 weeks later...
| SteveNuts wrote:
| There's also a lot of rumblings of massive layoffs coming at UNH,
| with senior leadership setting goals to be 50% offshore across
| the board.
| NewJazz wrote:
| I'm sure that using employees who will likely never use your
| services will improve the quality of their offering. Their
| website and call wait times surely won't go to shit.
| wongarsu wrote:
| The jokes write themselves: "Our reputation is in tatters and
| the pubic cheers for the person who killed our CEO. What should
| we do" "Let's make our service worse and sue our customers and
| their doctors"
|
| This feels more like a wounded animal lashing out than like a
| strategy decided in a board room
| snakeyjake wrote:
| The only thing they care about is next quarter's share price.
|
| The wouldn't kill and eat your grandmother if it was legal to
| make a little money, but 100% without exception they would
| look the other way and profess innocence if SOMEONE ELSE
| killed and ate your grandmother and it made them money.
|
| edit: and they would character assassinate and/or sue you for
| criticizing them in a large enough forum.
| lencastre wrote:
| That is the fourth D, or?
| throwway120385 wrote:
| Why don't they review the phone records and recordings of their
| phone calls regarding the patient? They were able to do that for
| my partner. They record all of their phone calls "for quality
| assurance purposes." I'm not surprised they're gaslighting now.
| It's how they always operate in these cases.
|
| I wouldn't be surprised if the person they talked to actually
| worked for Optum which is why UHC is denying that they would ever
| do anything so insensitive as call a doctor to deny a claim mid-
| surgery.
| Aurornis wrote:
| > Why don't they review the phone records and recordings of
| their phone calls regarding the patient?
|
| They did review the call. The calls did not support the claims
| in the social media post. The physician posted the letter she
| received on Instagram and, to be honest, I'm having a hard time
| siding with the physician:
| https://www.instagram.com/p/DFlR1CrJ688/?img_index=4
|
| Unless you believe that UHC's lawyers are lying about their
| records (which I have no doubt many people will claim) then it
| appears the errors were primarily in the administration at the
| hospital.
|
| Specifically, UHC did not demand she scrub out of surgery, but
| that she call back as soon as convenient. The physician spun it
| on social media as UHC demanding she leave surgery for the call
| immediately, but that seems like a miscommunication in the
| hospital staff.
|
| They also appear to have records that the hospital submitted a
| request for outpatient surgery but they were doing inpatient
| surgery, which prompted the calls.
| ceejayoz wrote:
| > Specifically, UHC did not demand she scrub out of surgery,
| but that she call back as soon as convenient.
|
| Which means "now, or you'll wait on hold for hours".
| IncreasePosts wrote:
| Why don't you review the articles that talk about what they've
| done?
| surfpel wrote:
| Naturally. I'd say they'd be willing to kill to keep their
| reputation up, but that's already their business model so...
| perihelions wrote:
| Also discussed on /r/medicine if that piques anyone's curiosity,
|
| https://old.reddit.com/r/medicine/comments/1igp35p/follow_up... (
| _" Follow up: The doctor who was pulled out of surgery to call
| UHC because they were denying her patient's stay got a
| threatening letter from UHC for talking about it on social
| media"_, 181 comments)
| Aurornis wrote:
| That links to a post containing the actual letter from the
| lawyers, which is honestly more revealing than all of the
| articles and social media ragebait about the situation:
| https://www.instagram.com/p/DFlR1CrJ688/?img_index=4
|
| I know people will default to believing the physician and not
| the lawyers, but from my read of the letter it appears UHC's
| lawyers have valid points (don't shoot me, I'm just the
| messenger)
|
| Specifically, UHC appears to have recordings of the calls and
| the paperwork which contradict the claims in the social media
| post.
|
| The two biggest problems I see from my quick read:
|
| 1. UHC's rep said the issue was non urgent and asked for a call
| back "when convenient to you". This differs from the social
| media post claiming that UHC called and demanded she "scrub out
| of surgery" and "call right now".
|
| 2. UHC has records of the doctor conceding that her office's
| submission for inpatient care was erroneous and that they
| actually meant to request observation care. That's why UHC was
| calling.
|
| The fact that UHC came with receipts (recordings of the phone
| calls) and that the doctor even conceded the error during the
| call does not put the doctor in a good position. The original
| claim that the insurance rep demanded she scrub out of surgery
| immediately was a red flag that something was amiss with the
| story.
| martimarkov wrote:
| I don't record my conversations and if some lawyer tells me
| that they have a recording of me saying something I'd be more
| inclined to believe them. "Maybe I actually said that? Maybe
| I made a mistake? Maybe I don't remember it now correctly?"
|
| So I'd take it with a pinch of salt but the lawyers might be
| absolutely correct as well. I'm just saying I can see it as a
| tactic but maybe I'm a bit paranoid. Wondering if just I
| jumped to this conclusion?
| Aurornis wrote:
| It's not a bluff, it's basic practice to record calls when
| the interactions are high stakes. This was just a social
| media fight, but when the issue is malpractice or someone
| has died you can guarantee the lawyers will want recordings
| of those calls.
|
| In states where recording requires consent you will get a
| pre-recorded message at the beginning of the call warning
| you that it's being recorded.
| scythe wrote:
| >1. UHC's rep said the issue was non urgent and asked for a
| call back "when convenient to you". This differs from the
| social media post claiming that UHC called and demanded she
| "scrub out of surgery" and "call right now".
|
| Based on my experience with some hospitals, it's possible
| that something like this happened:
|
| UHC [on phone]: We'd like to speak to Dr. X when possible
|
| Reception [on phone]: Sure, s/he's available
|
| Reception [to doctor]: Stop the surgery! United Healthcare
| needs to speak to you immediately!
|
| Dr. X [frantically undressing]: I can't believe these
| vampires are so demanding!
|
| Disclaimer: I contract for hospitals. I usually have good
| experiences working with management, doctors, nurses, and
| technologists. Practically all of the bad experiences are
| with reception and security (a few places are good at it, but
| not most). I've never seen people more devoted to making sure
| things don't get done. I am always happy to give them my ID,
| my company ID, use the metal detector, search the bag -- I
| don't care. But they always, inexplicably, insist on calling
| someone in the department, who is usually busy, who doesn't
| need to actually do anything, and nonetheless, we must slow
| everything down and bother them. I don't know who writes
| these policies, but I could see this happening.
| Aurornis wrote:
| That was my guess, too.
|
| The surgeon went to social media blaming UHC for
| everything, with the assumption that her own staff couldn't
| have been part of the miscommunication or paperwork errors.
|
| UHC comes back, with receipts, showing that the error is
| somewhere on the hospital side.
| perihelions wrote:
| UHC is still legally deficient in that hypothetical.
| Defamation of a public figure needs actual malice and
| knowledge (or reckless indifference) of falsehood--both
| absent.
|
| There's a large gulf between being wrong and being
| libelous.
| legitster wrote:
| Not necessarily. They sent her a letter asking her to
| retract her post. If she refuses to do this, then they
| have grounds for knowledge and malice.
| perihelions wrote:
| That's not actual malice. The doctor has no positive
| obligation to spend time reading UHC's letters pleading
| their version of the story, or interact with them in any
| way at all. Failure to engage with them is not malice.
| kmeisthax wrote:
| That's certainly plausible... however, UHC is _not_ saying
| "the doctor got it wrong, it was her receptionist's fault".
| They are sending legal threats - "take this speech down or
| we'll sue you for defamation". This is not a company trying
| to take their name out of the mud, this is a company trying
| to cut off their critics' tongues, because the critique is
| hurting the stock price.
| UncleEntity wrote:
| I've heard on the youtubes that "provably false
| statements" are considered "defamation" in some
| jurisdictions.
|
| But what do lawyers know?
| legitster wrote:
| > I've never seen people more devoted to making sure things
| don't get done.
|
| This is the truth. People do not understand the depths of
| hell you are in when you are dealing with hospital admins.
| benatkin wrote:
| Keep in mind that this is enshittification and that tech
| enshittifiers are doing the same thing. At one time UnitedHealth
| was competitive in quality of coverage, while still along with
| most or all of their competitors being awful by any absolute
| standard. Now they're capturing extra money at the expense of
| their reputation, and aren't trying to bring their reputation
| back but merely to slow its decline. If it causes their market
| share to shrink there are bankruptcies and tax write offs to
| pursue and their investors can invest in other firms and the
| deadly grift continues.
| franktankbank wrote:
| > competitive in quality of coverage
|
| Doesn't mean much in a sanctioned cartel. Everyone in the
| cartel can agree the prices must go up. The industry is rotten
| and quibbling about who is relatively worst doesn't improve a
| long term picture.
| Mistletoe wrote:
| This should help things a lot. I've completely forgotten about
| Barbra Streisand's house!
| aljgz wrote:
| Would be soon renamed to Streisand-UnitedHealth effect?
| miah_ wrote:
| Scumbag companies continue to be scum.
| wesselbindt wrote:
| Depose
| mitchellst wrote:
| I want to complain a little about the journalism (not) being done
| here. Because I read this article, and I read the (better, but
| still lacking) Bloomberg Law article it links/rewrites, and I
| still have no idea what's happening.
|
| The law firm says the surgeon made false claims. (Which claims?
| Were they false?)
|
| The surgeon reacted with some twitter grandstanding saying she
| was on the side of the women she cares for who are battling
| cancer. (Noble, but irrelevant. She can tell the truth for a good
| cause or lie for a good cause. Which did she do?)
|
| UHC's spokesperson makes a big show of saying there are "no
| insurance-related circumstances that would ever require a
| physician to step out of surgery" and they would "never ask or
| expect that." Happens all the time actually, in part because if
| you don't work on the insurance company's schedule and answer
| their calls, you may not be able to talk to them for weeks, and
| your patient is denied in the meantime. But is that what was
| happening here? Apparently nobody thought to ask or include that
| information.
|
| The implication of this news item is that UHC has hired a
| shakedown operation to chill criticism on social media. Big if
| true. But it seems to really matter whether the people on either
| side are telling the truth. Somebody should report that out.
| Alas, I guess "big company vs plucky surgeon in social media
| spat" is a simple script that requires no work, we don't need to
| be curious about who the hero(ine) and the villain are.
| dingnuts wrote:
| >Alas, I guess "big company vs plucky surgeon in social media
| spat" is a simple script that requires no work, we don't need
| to be curious about who the hero(ine) and the villain are.
|
| spoken like someone who doesn't have a chronic illness
| requiring an expensive medication to be delivered every month
| for the rest of their life, who every year has to fight with
| the insurance company about the fact that multiple sclerosis
| does not go away and that the medication is still needed, and
| yet STILL has lapses in receiving the pre-approved and approved
| and re-approved treatment which causes new symptoms to occur
| and old ones to relapse while the bureaucrat at the insurance
| company who is incentivized to give you the runaround plays
| delay deny delay deny delay over the medication that has been
| effective for YEARS and will be needed indefinitely.
|
| No, we really do not need to be curious about who the villain
| is. If UHC is worried about their image, maybe they should DO
| THE THING THEIR CUSTOMERS FUCKING PAY THEM TO DO
| JumpCrisscross wrote:
| > _maybe they should DO THE THING THEIR CUSTOMERS FUCKING PAY
| THEM TO DO_
|
| Health insurance in America is broadly profitable. But note
| that UHC just paying out claims puts them in the same place
| as California home insurers. Part of the job of a health
| insurer is to deny unnecessary claims, to be a check on
| providers, both in procedures and their pricing.
| Aurornis wrote:
| > Health insurance in America is broadly profitable
|
| Health insurance is actually a lot less profitable than
| most big businesses. Something like half as profitable as
| the S&P 500 average.
|
| But ignoring that, there are also big non-profit insurers.
| They aren't appreciably different.
|
| There's a big misconception that if we could just remove
| profit from our healthcare system every problem would be
| solved. However, if you look at where healthcare dollars
| go, profit and administrative overhead (insurance, hospital
| admin, etc.) are a single digit percentage of overall
| spending. If you could wave your magic wand and make it go
| away tomorrow, things would barely change.
|
| Note that even countries with socialized medicine have
| administrative overhead in the single digit percentage
| range, so it's not actually possible to drive it to zero.
|
| We severely overestimate how much of our healthcare dollars
| go to profits and executive compensation. I think because
| those are the only safe targets to be mad at. Nobody wants
| to engage in conversations about getting surgeons to take
| lower compensation or limiting certain types of care (which
| is very much a thing in any medicine system). American
| healthcare is expensive, but we Americans also consume (and
| demand) much more healthcare than elsewhere in the world.
| JumpCrisscross wrote:
| We have a lot of unnecessary gatekeeping. Prescriptions
| come to mind.
|
| Unless it's addictive or subject to group effects (
| _e.g._ antibiotics), it should be OTC. If someone kills
| themselves self administering another YouTube cure,
| that's on the influencer and the patient.
| s1artibartfast wrote:
| I ran into a murderous rage last year trying to buy
| kidney friendly cat food because it required a
| prescription.
|
| Not sure who's life those regulations were saving.
| JumpCrisscross wrote:
| Omg, pet medicines! I wound up getting several when I
| went to India. Only edit I had to make was to the dose,
| since they were packaged for people.
| sneak wrote:
| The nice thing about having grown up in and around the
| underground cash economy that drives the USA is that I
| never forget that it's usually cheaper and easier to just
| call your guy than to go wait in line like a schnook.
|
| My first box of Paxlovid was bought for cash.
|
| When Germany offered me only NSAIDs the 9th day after
| using a bone saw on me, the black market was there for me
| too.
|
| Seems cat food would be an easy one. Want me to ask my
| guys, or are you sorted now?
| s1artibartfast wrote:
| The cat is dead now, but not before I was squeezed for a
| few grand by excessive regulation. At the time, I was
| wishing there was an underground option for blood
| testing. You don't need a 300k degree to stick a needle
| in a cat or read a PDF to me.
|
| Kinda like how a barber in my state need a 20k license
| and 1000 hours of training, but on steroids. At least at
| home haircuts aren't illegal (yet).
| knappe wrote:
| Right, so we can just ignore the fact that of the top 10
| profitable worldwide biotech/pharmacy companies _5_ are
| US companies.
|
| https://www.statista.com/statistics/272720/top-global-
| biotec...
| JumpCrisscross wrote:
| Paywalled. But are any of them insurers? (Or coowned by
| one?)
| ceejayoz wrote:
| Oh, they have their deals.
|
| https://www.propublica.org/article/take-the-generic-drug-
| pat...
|
| > Faced with competition, some pharmaceutical companies
| are cutting deals with insurance companies to favor their
| brand-name products over cheaper generics. Insurers pay
| less, but sometimes consumers pay more.
| knappe wrote:
| I'm not really sure I understand the rebuttal. Are you
| implying that pharmacy companies play no role in
| healthcare generally? If you make that claim I assume
| you've never had to fill a prescription, ever. Because
| pharmacies and drug prices play a GIANT role in the cost
| of healthcare. I mean, even the US government feels this
| way
|
| https://www.cms.gov/newsroom/fact-sheets/medicare-drug-
| price...
| franktankbank wrote:
| > Part of the job of a health insurer is to deny
| unnecessary claims, to be a check on providers, both in
| procedures and their pricing.
|
| How can this occur with the given incentives? You have
| parent corp UHG who owns the whole vertical and you've got
| dumb fucking congress (deduced from Hanlon's razor) saying
| only a single part of that vertical is capped.
| JumpCrisscross wrote:
| > _You have parent corp UHG who owns the whole vertical_
|
| The group's gross profits are in line with the legal
| 80/20 rule. And more-integrated models (Kaiser) exist
| with better satisfaction ratings.
| lotsofpulp wrote:
| Even Kaiser is bumping up against resource constraints
| (at least in Washington). I know quite a few Kaiser
| employed doctors and insureds, and they all report
| declining quality.
|
| Edit: I scrolled down and saw someone else say the same:
|
| https://news.ycombinator.com/item?id=43016691
| mysticllama wrote:
| so glad the company that pays for my treatments can be "a
| check on providers" for me... /s
| JumpCrisscross wrote:
| > _glad the company that pays for my treatments can be "a
| check on providers" for me_
|
| Outside large hospitals, there is an alternative: pay
| yourself. You can usually draw down against an FSA or
| HSA, or just eat the cost. Only works if you're wealthy,
| of course. But most small providers have a cash rate
| they'll tell you verbally but never in writing that is
| below their official negotiated rate.
| nineplay wrote:
| All of the job of for-profit health insurance companies is
| to make money for their investors. Everything else they do
| works towards that goal.
|
| Now all of the job of any for-profit company is to make
| money for their investors, that in and of itself is not a
| problem. The problem is that specifically, for health
| insurance companies, they make money by denying people
| health care. They have no incentive to pay claims beyond
| the minimum necessary.
|
| We have public health care too and it isn't perfect but
| they don't lie to our faces when telling us why they won't
| cover something.
| s1artibartfast wrote:
| With the 80-20 rule they actually make money on the
| claims they pay, not the ones they deny.
|
| It is essentially cost plus 20%.
|
| The tricky parts are balancing opex to profit, and
| balancing coverage with competitive costs.
| Aurornis wrote:
| > The law firm says the surgeon made false claims. (Which
| claims? Were they false?)
|
| The letter seems clear to me, and unfortunately for the doctor
| they have receipts (phone call recordings and the paperwork)
|
| The biggest problem for the doctor is that they have a record
| of the doctor conceding that the wrong paperwork was submitted
| by her office (hence the call) and that the UHC rep asked for
| her to call back when convenient (not in the middle of
| surgery).
|
| I think the UHC doctor got carried away, assumed all mistakes
| were on UHC's end rather than her own admin staff, and then
| went to TikTok to tell a viral story with an exaggerated (at
| best) version of events.
|
| > Alas, I guess "big company vs plucky surgeon in social media
| spat" is a simple script that requires no work, we don't need
| to be curious about who the hero(ine) and the villain are.
|
| This mentality that we must pick a side, where one side is good
| and the other side is bad, is a huge problem with social media
| ragebait.
|
| We can admit that the surgeon was wrong to make a viral TikTok
| with information that was somewhere between very misleading and
| an outright lie. Admitting this doesn't make UHC the good guy
| or the hero.
|
| You don't have to pick a side. You shouldn't automatically
| assume viral TikToks are true because they are targeted at
| companies you dislike.
| xp84 wrote:
| As far as I'm concerned, I still appreciate the propaganda
| value of a story even if it's full of half-truths like this
| one, because it's time for a reckoning for these companies.
| There's a tiny, like 1% chance, that someday we'll have the
| opportunity to institute single payer and kill these
| businesses full of sickening, greedy ghouls overnight, and
| anything that helps convince people of their sins so that
| they won't doubt that it's worth doing, I'm okay with.
| They've earned it with their many, many, 100% factual bad
| deeds. And they've never been above lying.
|
| I admit that taking this attitude toward falsehoods isn't
| 100% ethical, judged by itself, but if it helps to end a
| system that has killed many thousands and will continue to do
| until it is abolished, this is a rare case where I'm ok with
| the ends justifying the means.
| gruez wrote:
| >As far as I'm concerned, I still appreciate the propaganda
| value of a story even if it's full of half-truths like this
| one, because it's time for a reckoning for these companies.
|
| Just like "2 weeks to flatten the curve" and "masks don't
| work"? There's no way that "the ends justifies the means, a
| little lie to advance our cause" would backfire, right?
| xp84 wrote:
| Indeed, I didn't like the dishonesty there. There's
| probably many situations where you're absolutely right.
| It's just that my hatred for this industry is too strong
| to grant them any quarter even when they're technically
| in the right.
|
| Because the fact is true that even though they probably
| didn't demand to speak to the surgeon immediately,
| there's a reason the staff deemed it worth pulling her
| from surgery, and it's because if she didn't get to talk
| to the caller _right now_ when they were on the phone, it
| could be any number of days before the matter could be
| resolved, and the hospital may not be willing to proceed
| if the insurance company is going to deny the claim,
| since that could saddle the patient with an unexpected
| $10,000 bill. In this way, our shitty system, designed on
| purpose by companies like UHC, forced most of this to
| happen.
| gruez wrote:
| >Indeed, I didn't like the dishonesty there. There's
| probably many situations where you're absolutely right.
| It's just that my hatred for this industry is too strong
| to grant them any quarter even when they're technically
| in the right.
|
| You know what's arguably worse than insurance companies?
| Racists. So when there's a mysterious flu coming out of
| China and racists are latching onto it as a way to hate
| on Chinese people (eg. "China flu"), we better downplay
| it[1] so we don't give them any rhetorical ammo.
|
| [1] https://www.cnn.com/asia/live-news/coronavirus-
| outbreak-01-2...
|
| >there's a reason the staff deemed it worth pulling her
| from surgery [...]
|
| Sounds like you're giving infinite charity to the
| doctor/staff and not allowing for any possibility that
| any sort of mistake on their end. Is this based off of
| any facts, or your "hatred for this industry is too
| strong to grant them any quarter even when they're
| technically in the right"?
| lovich wrote:
| You linked an article titled "No Clear Evidence Wuhan
| Coronavirus Can Spread Before People Show Symptoms" from
| _January 27 2020_.
|
| The headline is accurate, at that point in time nothing
| about the virus was clear. The only portion of this
| article that even tries to downplay anything about China
| is this portion which as far as I know is still accurate.
|
| > On the call with reporters, Messonnier also seemed to
| allay concerns that the virus could be transmitted via
| packages sent from China. Coronaviruses like SARS and
| MERS tend to have poor survivability, and there's "very
| low, if any risk" that a product shipped at ambient
| temperatures over a period of days or weeks could spread
| such a virus.
|
| > "We don't know for sure if this virus will behave
| exactly the same way," Messonnier said, but there's no
| evidence to support transmission of the virus via
| imported goods.
|
| Why are you trying to paint that as doctors lying?
| gruez wrote:
| >Why are you trying to paint that as doctors lying?
|
| the exact wording I use was "downplay", not "lying".
|
| >The headline is accurate, at that point in time nothing
| about the virus was clear. The only portion of this
| article that even tries to downplay anything about China
| is this portion which as far as I know is still accurate.
|
| Even though the headline is technically accurate, the
| "downplay" part comes from the CDC trying to imply that
| the risk was low.
|
| "Messonnier repeated her message that the immediate risk
| to the US public is low at this point."
| franktankbank wrote:
| I like how this case hinges on whether the call center
| employee said "at your convenience". It seems like its double
| edged to even admit such a thing.
| gruez wrote:
| Why? They presumably have recordings so it's unlikely to
| going to devolve to a "he said she said" situation, and I'm
| not sure how else you would rephrase "at your convenience"
| so the doctor wouldn't scrub out. Does every interaction
| need a 1 paragraph disclaimer to guard against a social
| media shitstorm?
| franktankbank wrote:
| The fact that a Doctor has to be worried about this shit
| at all is damning. The fact that a patient doesn't even
| pick their insurance (mostly tied to employer HR) is
| damning. The fact that a group can own the whole vertical
| is damning. The whole mechanism is a knot and anything
| less than untying it is going to have scary consequences
| I think.
| TheCoelacanth wrote:
| It also matters whether they are actually reachable at your
| convenience. A lot of business are virtually impossible to
| actually talk to unless you answer their call. They say to
| call back at your convenience, but you will only get their
| voicemail or an infinite waiting queue.
| nineplay wrote:
| The call center employee said 'at your convivence' knowing
| full well that they'd never be available at a convenient
| time.
| lotsofpulp wrote:
| It was 2024, it should not hinge on that at all. We have
| asynchronous communications, a timestamped email should be
| all the proof required.
|
| If UNH requires others to communicate with them via
| complicated phone trees that waste callers' time, then that
| means UNH is automatically at fault.
| franktankbank wrote:
| Precisely!
| IG_Semmelweiss wrote:
| Agree.
|
| You have pesky PHI in the middle. Funny how of all
| things, PHI hasn't done a thing to prevent data leaks in
| healthcare, but it has done fairly well in hindering all
| async communications with payors.
| lotsofpulp wrote:
| That's not an excuse. There are messaging systems inside
| electronic medical record software they can use. If my
| healthcare provider can communicate to me via a website
| and show me all my labs and results and even synchronize
| with the Apple health app on my phone, surely, a doctor
| should be able to message an employee of the managed care
| organization.
| legitster wrote:
| If anything, the doctor is admitting to a potential crime!
| Medical providers aren't supposed to deny procedures based on
| insurance coverage. Even if UHC called during surgery to say
| the claim was denied, it's the doctor's choice to do the
| surgery of not.
| mlyle wrote:
| > Medical providers aren't supposed to deny procedures
| based on insurance coverage.
|
| This is false. There's EMTALA, which requires that
| emergency services will be provided until a patient can be
| transferred. But doctors absolutely refuse to provide
| services based on ability to pay all the time.
| legitster wrote:
| Good point. But as the original story made the rounds on
| social media, it got exaggerated to make it sound like
| this was a life-threatening surgery. Knowing that it was
| a routine call and it was a plastic surgery procedure
| definitely deflates the scandal of the whole thing.
| ceejayoz wrote:
| Removing a brain tumor is "life-threatening surgery", but
| it won't be subject to EMTALA requirements.
| nradov wrote:
| Well that would depend on the facts of a particular case.
| If a patient presents at the ER with a brain tumor which
| is causing severe symptoms such as unstable vital signs
| then under EMTALA the hospital might be legally required
| to remove the tumor regardless of the patient's ability
| to pay.
| ceejayoz wrote:
| No; the tumor itself would be non-emergent. The symptoms
| it causes - pain, for example - would be treated, then
| the patient would be discharged with a suggestion of a
| follow up with oncology.
| nradov wrote:
| Are you certain about that? I think it would really
| depend on the severity of symptoms. Cases like _Munoz v.
| Watsonville Community Hospital et al_ indicate that
| courts have interpreted the legal requirement to
| stabilize the patient rather more broadly. Just
| discharging the patient with painkillers and a referral
| isn 't necessarily sufficient to avoid liability.
| ceejayoz wrote:
| Yes; that case involves a clearly emergent post-surgical
| complication.
|
| https://casetext.com/case/diaz-v-division-of-soc-servs-1,
| as an example, involved a case where chemo was warranted
| for emergency treatment, but not on an ongoing basis. The
| court found they could treat enough to stabilize, then
| discharge, even if that guaranteed an emergent return
| later on.
| ceejayoz wrote:
| > Medical providers aren't supposed to deny procedures
| based on insurance coverage.
|
| Only in a very specific, narrow set of circumstances.
|
| https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_a
| n...
|
| It only applies to emergency assessment and stabilizing
| care, and only if the facility accepts Medicare patients.
| ranger_danger wrote:
| Thank you for such a well articulated response, I agree with
| you.
|
| I am not a surgeon but I have experience standing right next
| to them during surgeries. In my opinion, they already know
| that there is never a need to take a phone call from an
| insurance company during a case. Other reasons for a call may
| exist, sure, that part is not out of the ordinary... but
| insurance approval would have already happened before the
| case had ever started. Plus the overnight stay is not part of
| the billing for the surgery itself anyways.
| nineplay wrote:
| > the UHC rep asked for her to call back when convenient (not
| in the middle of surgery)
|
| I'll echo the above poster - when an insurance rep calls us
| we drop everything on the floor and rush to answer it because
| otherwise they will continue to deny our claim and not get
| back for weeks. Then they reject our claim because it's now
| outside their 3 month window.
| legitster wrote:
| In this case though, the claim should have been denied
| because it was filed incorrectly.
|
| Is there also a reason the surgeon themselves needs to get
| on the phone with insurance? Isn't that what the rest of
| the staff is for?
| nineplay wrote:
| > the claim should have been denied because it was filed
| incorrectly
|
| Spoken like someone who has never spent hours online with
| an insurance company. They have told me that they can't
| see uploaded forms due to a 'glitch'. They have told me
| fields were missing when I am looking at the same forms
| and telling them where the field is and what it contains.
| They have been carefully instructed to tell lie after lie
| after lie hoping that the consumer finally gives up.
| y33t wrote:
| I've seen the same damned thing. Even when the state has
| previously gotten involved on behalf of a patient, I've
| seen insurance try to deny a surgery less than an hour
| before it was scheduled. Patient's husband called up the
| state and they said to not worry about it, they'd handle
| it. But even still, _insurance companies do not stop
| trying it_. The penalties they get are a joke to them.
| Executives need to face criminal penalties and be locked
| up in federal prison. Fuck it put em in Gitmo, those
| people are terrorizing us all.
| nineplay wrote:
| The goal is to wear you out and it's the context missing
| from the discussion. An external observer could look at
| any of my contested insurance claims and say 'They asked
| for more information, you gave it to them, the claim was
| approved, so what is the problem?"
|
| What's missing is all the days I had to get up, check on
| my claim, and call them because the claim was still
| denied and they sure weren't going to call me.
|
| What's missing is the hours I spent on the phone with
| them taking them step-by-step through the same issue each
| time.
| roenxi wrote:
| That seems a bit incredible because it suggests that they
| would be denying 100% of their claims. If they're going
| to start lying about a form being filled out correctly in
| one instance, why ever stop? They can just keep lying
| forever on all claims.
|
| I've had weird experiences online arguing (about
| shoplifting, as it happened) with people (I assume
| teenagers) on Discord who seemed to have a genuine belief
| that buying insurance was a magic positive-sum process
| for dealing with damages. They hadn't/didn't make the
| link that the insurer pays out approximately what they
| take in from premiums. That experience applied to medical
| insurance leaves me with a strong suspicion that UHC gets
| a lot of hate because they are the cheap option and
| people haven't cottoned on to the sad reality that if
| they want their claims paid out they can't go with the
| provider that is cheap because it denies a lot of claims.
| UHC's margins are there but don't seem to be that
| impressive. It wouldn't be surprising if they have to
| push back fairly hard or become insufficiently
| profitable.
| IG_Semmelweiss wrote:
| the mistake in your assumption is that they are the
| "cheap" option.
|
| UHC have all kinds of plans, both cheap and expensive,
| and their denial rates are high, regardless of what plans
| are purchased.
| roenxi wrote:
| Knowing the general madness of US healthcare, I want to
| stress this isn't rhetorical.
|
| So why are people going with UHC?
|
| _EDIT_ I want to reply to 2 replies with the same
| comment, so I 'll put it here - if the companies are
| paying & buying known-dodgy insurance, then why aren't
| _they_ going with a cheap option?
| nineplay wrote:
| Because in the madness of our economy we've decided that
| people need to pay for their healthcare either out of
| pocket or through their employer. They have limited
| choices and often need to take the cheapest because its
| all they can afford.
|
| Fortunately for health insurance companies, people who
| need to take the cheapest healthcare could rarely fight
| back.
| lovich wrote:
| You have very little choice in healthcare in the US.
| While you have the "option" of trying to get healthcare
| on your own, if you have an income it's usually
| prohibitively expensive as most companies are able to
| both a: negotiate a better rate as a bulk deal for
| bringing all of their employees to the plan at once, and
| b: subsidize the plan for employees.
|
| What this means is that the most choice Americans face is
| whether to take the high or low deductible option their
| plan offers and whether they take the single or family
| plan.
|
| If your company picks UHC and you don't have a spouse
| whose job has something better, then you're getting UHC
| or nothing
| ceejayoz wrote:
| > So why are people going with UHC?
|
| Most get it through work, and most areas have only a
| handful that count local docs as in-network. If you're
| _lucky_ , work might offer a choice between two insurers.
| nineplay wrote:
| These companies - every company - know how to maximize
| profit. They know how many claims they can deny, they
| know what kind of claims they can deny, they know who is
| or isn't likely to fight back.
|
| Hint - the people with the fewest resource are the least
| able to fight back.
|
| UHC shouldn't have margins. Healthcare and profit are a
| deadly combination.
| legitster wrote:
| No, but my newborn had to go to the ER once and it kicked
| off 18 months of billing disputes with the hospital. And
| the thing I learned was the depths of incompetence,
| malice, and laziness that a hospital billing department
| was capable of.
|
| One of the key lessons - if a doctor submits an incorrect
| billing code, insurance can't do anything to change it.
| If a doctor doesn't want to work with insurance to fix
| the codes, you as a patient have so few options to do
| anything.
| nineplay wrote:
| I'm very sorry to hear that, I've been through any number
| of ER visits with my child. I have not personally had any
| issues with hospital billing departments, so perhaps I
| have been lucky. It is only the insurance I've had
| problems from.
| legitster wrote:
| But it's not the only billing problem I have had. A
| hospital billed us _double_ for an emergency c-section
| (once for the mother, and again for the child) and hit us
| with $300k in claims. A dermatologist once _faked_ a
| surgery and sent it to my insurance. And don 't even get
| me started on the exploitative agreements hospitals sign
| with ambulance companies.
|
| We're not even people who spend a lot of time in
| hospitals - but we are pretty close to a 100% hit rate
| for billing issues with hospitals. Even during times in
| my life when I didn't have insurance.
|
| I get that people kind of ascribe all sorts of medical
| billing problems to insurance companies. But I think a
| lot of it is kind of ignorance comes from inept hospital
| management shifting blame. And often doctors and
| practitioners themselves are very removed and unaware of
| the awful billing at their own practices.
| IG_Semmelweiss wrote:
| its called Peer to Peer.
|
| This happens all the time.
|
| Most independent doctors billing OON may also need to
| speak with 3rd party claims processor, in all likelyhood.
| Same is true for some WC/NF/Lien claims
| IG_Semmelweiss wrote:
| I think the false claims were on the Tiktok, but the crux
| that i detect is the issue "UHC called doctor out of OR" is
| likely true even if UHC didn't intend it that way.
|
| >>The letter seems clear to me
|
| Where is the letter?
|
| >> doctor conceding that the wrong paperwork was submitted by
| her office (hence the call)
|
| That is a strong assumption to make. The tack you are taking
| is that one of the 2 parties noticed a wrong PA was requested
| (and approved) and tried to do something about it, preop.
| That's the assumption. IF the PA was fine, and that's 100%
| shenanigans by UHC. Less likely, but still very possible.
| karuselli wrote:
| Starts at 0:07 into the doctor's video here (I don't think
| she posted the document outside of this format):
| https://x.com/epottermd/status/1888397730784883096?s=46
| jrflowers wrote:
| > Alas, I guess "big company vs plucky surgeon in social media
| spat" is a simple script that requires no work
|
| > UHC's spokesperson makes a big show of saying there are "no
| insurance-related circumstances that would ever require a
| physician to step out of surgery" and they would "never ask or
| expect that." Happens all the time actually
|
| You make a good point. UHC has said something that, according
| to your direct knowledge, is patently untrue, and yet this
| article contains nothing accusatory against the surgeon that
| said something contradictory to the statement that you assert
| is completely wrong.
|
| If one party says something wrong and another party contradicts
| them, reporting that is a failure of journalism becau
| gruez wrote:
| > [...] reporting that is a failure of journalism becau
|
| well? Don't leave us hanging!
| jrflowers wrote:
| Well as mitchelist points out we don't even know what
| claims were made. The third paragraph of this article reads
|
| > On Jan. 7, a plastic surgeon named Elisabeth Potter
| posted a video of herself on Instagram claiming that
| UnitedHealthcare called her mid-surgery and asked her to
| justify an in-patient stay for a woman who has breast
| cancer and needed a surgical procedure to treat it. Potter
| then claimed that the insurer denied the patient an
| overnight stay and threatened her with legal action for her
| posts.
|
| Are these claims? What does "surgical procedure" mean? In
| what way is she using the word "denied"? It says UHC
| threatened her with legal action for her posts but, as
| mitchelist has surmised, we don't know what she said or if
| she said anything at all.
|
| While the article articulates exactly what the surgeon said
| about UHC and links directly to her video of her saying it
| [1]... does it? Who knows what's going on? I'd write more
| here but I am using speech to text because my dominant hand
| is stuck inside a jar of honey and my wife's cries of "stop
| making a fist" (whatever that means) are getting picked up
| by my microphone.
|
| 1 https://www.instagram.com/p/DEid-1npNbA/?hl=en
| phendrenad2 wrote:
| I don't know much about Fortune magazine, but Wikipedia says:
| "The magazine competes with Forbes and Bloomberg Businessweek
| in the national business magazine category and distinguishes
| itself with long, in-depth feature articles"
|
| Which seems incredibly ironic given that this article is 3
| paragraphs.
| KennyBlanken wrote:
| 1)It's not, it's 9-10. 2)This isn't a "feature article."
|
| Maybe save judgement on journalists until you can parse 5th-
| grade-reading-level sentences correctly.
| xu_ituairo wrote:
| Your response feels unnecessarily unkind
| bradleyishungry wrote:
| When you comment in bad faith you get unkind responses
| KennyBlanken wrote:
| > The law firm says the surgeon made false claims. (Which
| claims? Were they false?)
|
| This is in the Fortune story. UHC provided a direct quote,
| right after some text you quoted, and the post continues on
| with the claims the lawyers make.
|
| >The implication of this news item is that UHC has hired a
| shakedown operation to chill criticism on social media. Big if
| true. But it seems to really matter whether the people on
| either side are telling the truth.
|
| Implication? UHC uses the services of a high profile law firm
| that openly advertises itself as specializing in "defamation
| matters and representing clients facing high-profile
| reputational attacks" and, sent a surgeon treating a UHC
| patient, a C&D letter, over a social media post.
|
| The firm worked for Dominion - and if anyone cares to look
| back, their record, like nearly every other electronic voting
| company, isn't very good.
|
| There's really nothing in the story that is unbelievable, and
| by your own admission we can see how they very carefully
| phrased it as 'never asked or expected'. This means she'd have
| to prove that missed calls resulted in delayed care for UHC
| patients - likely possible, but cumbersome...
|
| Frankly it seems like you didn't read the article fully, or
| you're being disingenuous.
| sneak wrote:
| I agree, but somehow when a lot of people fall on the "summary
| execution is warranted and encouraged" side of this debate, the
| specifics of any single given case end up far below the noise
| floor.
| ChrisArchitect wrote:
| Earlier source: https://news.ycombinator.com/item?id=42954798
|
| and Related:
|
| _UnitedHealth Is Sick of Everyone Complaining About Its Claim
| Denials_
|
| https://news.ycombinator.com/item?id=42992121
| gamblor956 wrote:
| Also relevant:
|
| https://www.washingtonpost.com/business/2025/02/10/inhaler-c...
| TLDR: UnitedHealth subsidiary Optum cut coverage for inhalers
| without bothering to tell patients in advance, or to let
| affected patients know of alternatives that were still/now
| covered, and a man died because of it. If the case goes to
| trial Optum is looking at a bankruptcy-level payout.
| Henchman21 wrote:
| Which is why I find it highly unlikely it will go to trial.
| legitster wrote:
| Obviously nobody in their right mind would defend the bean-
| counters at UHC. But also picking a side with the hospitals and
| making this a "them vs us" issue is pretty naive. Hospitals and
| providers are complicit in their own fair share of awful
| dealings, and you shouldn't automatically take their side.
|
| In this case, the irony is baked right in. UHC was calling the
| provider _because the provider_ legitimately screwed up the
| billing codes and was trying to overcharge the patient!
| cess11 wrote:
| It's absurd that a corporation can claim to have been defamed.
| It's like Harry Potter bringing a defamation case against some
| author of erotic fanfic.
| hsuduebc2 wrote:
| They will do anything in their power to not look bad except stop
| acting like complete garbage.
| hsuduebc2 wrote:
| And people should feel any compassion for architects of this. Lol
| more_corn wrote:
| "Our bad behavior is causing public backlash. Wat do?"
|
| Maybe stop behaving badly?
|
| "Naw, we'll lawyer up and crush those peasants."
| tzs wrote:
| UHC even manages to be shady with their Medigap plans. Medigap
| should be the hardest kind of medical insurance for a company to
| be shady with, but they manage.
|
| Brief background for people who have had no reason to know what
| the hell Medigap is: in the US if you choose traditional Medicare
| at 65 [1] it is pretty simple. Various preventative services are
| covered 100% with no deductible, and other services are covered
| with a $257 deductible and a 20% copay.
|
| You can buy "Medigap" insurance from private companies that help
| cover your Medicare copay and sometimes other things Medicare
| doesn't pay. Medigap plans are standardized by the government
| named Plan A through Plan N which vary in what they cover and how
| much they cover it.
|
| It should be hard to be a shady Medigap insurer because they are
| almost completely out of the loop. You go to your doctor, the
| doctor says you need say an MRI, you go get that done and the
| bill is $500. The MRI place sends the bill to Medicare, Medicare
| pays 80% ($400), and also notifies your Medigap insurer. The
| Medigap insurer then pays the remaining 20% ($100).
|
| The Medigap insurer doesn't have a say in whether or not they
| have to cover it. If Medicare approves covering their 80% then
| the Medigap plan has to cover it too. No saying that you should
| have went to a cheaper MRI place, or your doctor should have done
| some other cheaper test instead of an MRI.
|
| So if they can't be shady when it comes to coverage, what can
| they be shady on? They can be shady when trying to get you to
| sign up.
|
| Suppose you are in Texas and are turning 65 and are shopping for
| a Medigap plan. You decide you want plan G. On Medicare.gov for
| zip code 75002 (first zip code I found when searching for "Texas
| zip codes") there are 44 plan G Medigap plans available from 33
| different insurance companies.
|
| 30 of these companies are using "attained age" pricing. Premiums
| are low for younger buyers and go up as a function of age.
|
| 2 of them use "issue age" pricing. Your initial premium depends
| on your age when you buy, but does not then go up as a function
| of age.
|
| Finally, one company, UHC, uses "community" pricing. With
| community pricing the premiums are not a function of age. If you
| buy a community priced plan with a $200/month premium at 65 you
| might be paying say $300 at 75, but that won't be because of your
| age. It will be because of inflation. In particular when you are
| paying $300 at 75 that is also what someone signing up at 65 that
| year will be paying. Hence why it called "community" pricing--
| everyone on that plan pays the same.
|
| For someone at 65 typically an attained age plan will be cheaper
| than a community plan. So why would you ever buy a community
| plan? Buy an attained age plan, and a few years later when the
| price rises above the price of community plans switch plans,
| right?
|
| The problem with that is that in most states if you are joining a
| Medigap plan other than in a window around when you turned 65
| (and some other exceptional situations) the insurer is allowed to
| take age and pre-existing conditions into account. They can
| refuse to sell you a plan, or charge higher premiums, or exclude
| your pre-existing conditions from coverage.
|
| That means if you are in such a state and either have expensive
| pre-existing conditions or will be unfortunate enough to develop
| some later you may be stuck with the Medigap plan you first buy.
| Then a community rated plan can make a lot of sense. If you are
| going to be stuck with your plan a $200/month community plan may
| be more attractive than an attained age plan that is $150/month
| now that will be rising to $350/month over the next say 20 years.
|
| OK, so now imagine you are 65. You've entered 65 as your age in
| the plan finder at Medicare.gov. You see all those plan G
| attained age plans which start at $133/month, and the issue age
| plans that start at $166/month. And then there are the UHC
| community plans starting at $166/month.
|
| That sure looks attractive. $166/month that doesn't change as a
| function of age will in a few years be a better deal than
| $133/month that goes up as a function of age.
|
| When you follow the link to the plan website and fill in your
| information you will indeed be told it is $166/month (or close).
| But under that there is a line that says "$308.39 standard
| premium" with the $308.39 struck out. And below that it says
| "Includes $138.78 in discounts".
|
| They are apparently claiming it is a community priced plan
| because everyone has a standard premium of $308.39, but then they
| give an age based discount. If you are 65-67 it is 45%. Then it
| goes down 2% a year through age 79. Then it goes down 3% a year
| until reaching 0 at age 86.
|
| I fail to see how this is not in fact an attained age plan. Based
| on what I've read on /r/medicare and other forums where people
| new to Medicare seek advice I'm sure that there are people who
| will not notice this and buy that plan thinking the premium won't
| be going up as a function of age.
|
| I believe that there are other insurers doing this same
| disguising of an attained age plan as a community plan, but is
| particularly scummy in the case of UHC because UHC has a deal
| with AARP to provide these plans under the AARP name.
|
| Medicare.gov does know that the price actually does depend on
| age. If you change you info on Medicare.gov's plan search to say
| you are 75 it does show a higher price for the UHC plan just like
| it does for the attained age and issue age plans, so if you think
| to do that you might catch that something is fishy.
|
| But if you are already predisposed toward UHC because of the AARP
| association and because you want community pricing, you might not
| see a need to try other ages since you would not expect that to
| matter.
|
| I'm in a state where they don't do those shenanigans. In my state
| all plans are community rated and if you signed up for Medigap
| when you turned 65 you can later freely change plans and
| providers and the new provider has to accept you with no
| exclusions for pre-existing conditions and with the same premium
| they charge everyone else.
|
| If UHC tried that discount trick here what would happen is people
| would sign up with them at 65 to get the 45% discount, and as
| soon as that discount has declined enough to where what they were
| actually paying was more than the plans of the other plan G
| providers they would switch to one of those.
|
| More and more states are liberalizing their rules for Medigap
| plan switching. Only a few are as liberal as mine (Washington)
| but several do allow you to easily switch between providers of
| the same letter plan with no penalties for pre-existing
| conditions and no higher premiums, and that should be enough to
| make the discount trick a losing deal for them. It's currently I
| think around 16 or 17 states that do this. It's a mix of red and
| blue things so this doesn't seem to be a partisan thing.
|
| [1] In "traditional" Medicare the government is the insurance
| provider. The alternative is "Medicare Advantage" where the
| government pays a private company to be your provider. Think of
| Medicare Advantage as a lot like what you get from plans with
| employer provided insurance or with plans bought on the ACA
| marketplace.
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