SMH
A 25-year-old suffered a catastrophic brain injury in a motorcycle crash and UnitedHealthcare is REFUSING to pay for the treatment that could help him wake up...
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At the very least, insurance companies should not have the right to make the decision on what they can approve or deny. It’s a basic conflict of interest issue.
Was that not how it used to be? I'm curious if someone can identify a timeline of when these companies started lobbying or simply redrafted their terms of service to limit input from doctors or even decisions to save people's lives.
Like anything, we need checks and balances. I do agree that the prior authorization thing has gone WAY to far now a days. Old folks remember all the kids needing their appendix removed for whatever reason in the 80s/early90s. Stomach flu? appendectomy. I remember as a small kid being scared of WHEN and not if my appendix would go. Then suddenly overnight, that disappeared. Only people at actual risk after getting testing were getting them. Ive been told that was the start of insurers requiring prior authorizations because of all the unnecessary "quick" surgeries that the doctor could crank out and make $$$ off of.
The site would crash. I’m a Utilization Review nurse at a hospital (review admissions and attempt to get the hospital stays approved by insurance, to put it simply). Denials from UHC are far and away the largest number and percentage. They are truly awful.
Agreed, the database would be far too large. I work denials for a large healthcare organization and UHC is the worst for us too. I’ve seen them deny a claim for missing required information (anatomical modifier) when it not only was on the claim form but it was shown on the claim in their own claims portal. They upheld the denial after multiple appeals. Just one example of the lengths they’ll go to deny a claim. They’re a disgraceful company.
I used to have UHC and in a sea of horrible insurance companies they stood out as the worst.
They denied a dental claim when their own policy says it's covered, I saw the denial letter and what their own policy says they cover. My dentist office then has to waste a bunch of time forcing them to cover what they cover. You know they do this on purpose because some providers won't spend the time fighting it.
Makes you wonder how high the accidental and preventable death rate is for insurers that had them as their insurance. Choosing UHC sounds like signing your own death certificate.
It came out (after the CEO assassination) that they had instructions to their claim personnel that everything should be denied the first time. Something about using AI for that, too.
That so sad, and angering all at the same time. From your perspective, what is the best (or only way) people can ensure that their claims get approved? The older I get the more scared I’m becoming of insurance and the entire system. And I’m in Canada, so I can’t even imagine the stress it would be for the average American.
If it’s something serious like a surgery they need and their insurance is denying prior authorization, the best thing they can do is harass their insurance. Unfortunately, you have to be a pain in the ass to get them moving. We have to do it to get denied claims paid too. They’ll stall and drag their feet as long as you allow them to.
That’s mostly before the visit or surgery takes place. Once authorization is obtained and the visit/surgery occurs and the claim is submitted, as long as the provider is contracted with the patient’s insurance, the patient shouldn’t have to be involved. Most types of denials result in a provider write off after appeal options are exhausted. It’s part of the contract that the provider has to accept the write off. They can’t balance bill the patient except for things like deductible/coinsurance/copay or certain types of denials like the patient’s insurance lapsed.
But even though the patient is spared a lot of balance billing, it takes a toll. When these insurance companies continuously reduce reimbursement, they inevitably reduce the quality and availability of care for patients. It may be different in Canada, I’m unfamiliar with their system, but this is how the US system works. It’s very broken.
We have Medicare for all in Canada. We pay into the system through our taxes, and doctor visits, hospital stays, surgeries, etc. is all free. Same as in the UK and several other countries. The American for-profit healthcare system is tragic and inhumane.
The man Mangione murdered pioneered a system that had an unusually high denial level in healthcare coverage circles to the point they were starting to get heat from the government, too, if I'm remembering right (or it could just be the higher ups all in on it together at UHC).
I take solace in the fact that for that single week Luigi probably saved the lives of thousands of people who'd regularly be denied lifesaving coverage because they were scared shitless of copycats.
They're also refusing to pay us physicians. We then take them to arbitration, per the no surprises act, and win 93% of the time. Now they are outright refusing to comply, and we're going to have to sue them in court for the money they owe. It will take years and they will will report record profits stealing our money.
But hey, isn't that the libertarian/capitalist dream?
I have been denied. They play the long game too. They deny deny deny send you to their AI customer service and AI claim case agents. Until you give up and let the ailment run its course or pay out of packet. I have done both because of UHC. They have also approved treated ent then denied it after the fact because the anesthesiologist called in sick and they used a different on call doctor. So fought that surgery until I paid when they threatened claims.
They deny stuff they cover hoping the doctor/dentist office won't fight it, that happened to me when I had UHC. The scary thing is Cigna is MILES better than UHC.
Because on the off chance they actually cover at least some of a procedure or visit it all saves thousands+ out of pocket. One monthly medication is $10 with insurance and $250 without, another is free with insurance and up to $1500 without. Both are required if I want to live a normal life. I can pay $50 to go to an appointment instead of $300. It's this kind of shit that keeps us dependant and buying in, but when we truly need it, we're f*cked. My aunt had cancer, and if she could get treatment right away she likely would have survived. Instead months were wasted trying to track down any "in-service" providers that were capable of treating her, then finding approved treatments. Then dragging their feet through every single decision. And, we'll, you'll notice I'm speaking of her in past tense.
No kidding, my wife was denied a radiation treatment for her breast cancer due to being "experimental" then after weeks of no answer from cough United Healthcare cough her dr basically said fuck it get up here for radiation and dont worry I'll deal with insurance.
An incredible doctor forced to spend hours on the phone arguing with United instead of treating more people. Another quiet cost of these shitbag insurance companies.
UHC denied an overnight stay claim when my wife had sepsis and had mentioned she felt fine after the first round of antibiotics. That was the reason for the denial. They pumped her with three rounds of antibiotics over 18 hours, ofc she had to stay. Hospital covered it ($33K bill) as far as I know. Fucking UHC.
Dude I had my doctor's say something similar! For something less serious tho. Which goes to show you doctors are fed up with it to. If they believe you need treated then that should be the end of that. BOOM treatment for all... wild that this is an outrageous statement I just said
In my opinion, for-profit insurance, regardless of what is insured, should not be a thing. I think I can safely say that for-profit insurance companies have a higher incentive to deny claims to maintain profit margins and as long as they stay for-profit, these stories will continue to come up.
There's no need for a few people to make MILLIONS while most of those that pay the premiums aren't even making a tenth of the bonuses and/or pay packages that those top level employees receive. It's greed, coupled with more greed, and that greed pays for new laws/regulations to maintain those levels of greed. The scummiest of scum.
Exactly! Insurance is sold as this rosy little co-op, where everyone pays into a pot, then if something happens to someone they get to take money out of the pot to cover it. But that model completely falls apart when you have a third party controlling the pot (the insurance company), deciding how much gets paid in and when and how much it pays out, while drawing their income from the pot as well. That's such a huge conflict of interest inherent to the business.
As such, insurance is more like a casino than anything else. And, just like casinos, the house always wins.
It’s very rare. They went overboard with this case due to the public sentiment and the support for Luigi scared them.
Technically, the feds and state can charge u for the same crime (“separate sovereigns”) but it’s very rare bc it’s seen as overstepping. However, only in the state of NY, there is a statute that really limits the federal govt from such prosecutions, so he could very well win this double jeopardy argument.
I bought the most expensive United Healthcare plan my employer offered. United Healthcare denied every singe claim we submitted-- even our annual physicals for every person in the family. They made us fight for every claim. Fuck united healthcare
Was exposed to the 1% a lot when I was younger. You hit the nail on the head. Some people would be shocked to learn what little value their lives are seen as having to the truly rich. You are sub-human to the rich. They respect their dogs more than you.
It's really bold right for entitled nepo babies who depend on entourages of people to do everything for them. From planning their children's birthday parties, to burping their perfect manufactured test tube babies, buying the gifts, wrapping the gifts, chopping their food, putting the child to bed etc. Nannies, butlers, landscapers, drivers, on and forth.
For people who rely so much on other people it feels like a twilight zone episode
I went to university in Florida and met these twins whose dad owns one of the largest yacht brokerages in Miami. Neither of them had ever worked a day in their lives. They drove a Ford Raptor and a BMW M4 Competition and lived in an $850k house 2 block from the beach that their dad had bought for them. They lived there throughout university and didn’t pay a dime toward rent, food, utilities, or anything else.
One time, when we were just chilling and drinking, these dudes went on a hardcore rant about how lazy people are and how people on disability or food stamps are all scumbag con artists who deserved to die. And they were 100% serious, they genuinely saw nothing wrong with their view.
Following this sentiment with examples of my own. The two wealthiest families I’ve known ($10M+) live incredibly privileged lives, thanks to the wealth their forefather’s passed down.
All of them have never experienced, or can even imagine what it’s like to want something and not get it. All of them think middle class America needs to “work harder to make it in life”, not realizing they literally have never “worked” a day in their lives.
So true. Family member with a high school diploma made lots of money through tech and looks down on rest of our middle class family. He leads the local Trump boat parades at his yacht club. His FB page shows he is grad of state university with a degree, which is a lie. Went to college for a quarter and dropped out. Those of us who actually have degrees are mocked.
There’s no real cure, but if you dig deep enough, you’ll appreciate your integrity.
Which sounds trite, also grating, but it really is true that you can feel the actual hum of your decency when you make peace with it all.
I’m not going to tell you what to do with this but if someone is saying that on their Facebook profile there’s a good chance they got in with a company back before they had background checks and lied about their education.
Money isn’t a game changer. It just brings out the persons true self. If you’re an asshole and broke you tend to hide it because you don’t have a leg to stand on. Now, add money to the equation, and the asshole comes right out. On the other hand, if you’re truly a good person adding money won’t change that.
I hope that eventually reality will slap them upside their head, but I'm sure that will never happen. They are set for life because of the family they were born into.
Ya know.... If memory serves me correctly, in the Christian mythology, Lucifer holds a position much like a prosecutor, accusing mankind of not being worthy of free will... And that angelic kind should be loved above all other creations. Thus, his rebellion. Here on Earth, he has the power to tempt us to sin. Not with the intent to punish, but rather proving his point that we are unworthy of God's love.
Utilizing the tools of mankind against us. Making hypocrisy and lawlessness the norm. Putting the most devilish people into power, especially in churchs. Infiltrating the holiest of groups to do the most evil things in God's name (genocide z murder, suicide bombing, etc).
When you look at things from the pressumed perspectives of what would be "demons", all of the worst things in our society are perversions of our most well intentioned efforts. And it usually takes little more than appealing to a politicians greed or deviant sexual proclivities.
Burn this piece of shit system to the ground. It is our right. The social contract is broken. Our rights are bastardized and we pay the price. Fuck the oligarchs, the wannabe kings and all who think they are greater than. This must stop.
Nearly all of the patients in my hospital waiting for rehab beds are waiting for insurance approval. They tend to deny and keep denying for about 3 to 5 days. They are hoping that they get better on their own and just go home or die in the interim.
Americans be like "I don't want universal healthcare cause it will increase wait times." Like, lmao better to wait a few days than just be left to die 🤣
I don't know how you can all live there and not riot every day.
From Europe it seems like you'd all rather argue about 'the left' or 'the right' rather than coming together and stopping this absolute dystopian nightmare you live in.
Most American's haven't ventured anywhere outside of the US and don't understand what life *could be like* if they simply made better choices with their leadership.
If you riot, you’ll be hospitalised, then billed, sued and prosecuted for stuff that never happened. You’ll accept a plea bargain and life long obedience to your overlords. This is the ‘civilised promise’.
I remember when Obamacare was first being introduced and the plan was to include a public option. One of the talking points surrounding that was that there would be government run “death panels” who would be able to deny you treatment for things. Funny, this sounds a lot like a corporation acting as a “death panels”.
I can weigh in on this as a former ICU nurse. Different facilities provide different levels of care and treatment. This boy is likely needing a higher level of care than the rehab facility can provide and would be unable to perform the treatment regimen. Based on the neuro status I saw I this video it makes complete sense to me why he is not a candidate for a rehab facility and should be going to a skilled nursing facility which the insurance company IS willing to pay for. It sounds like a case of a family not wanting to accept the prognosis and not understanding why the facility insurance is denying would be inappropriate for him. A lot of this falls on his care team and failure to educate however for some families nothing you say is ever going to get through to them.
It’s sad and it’s awful but not every insurance denial is evil and sometimes it does make medical sense.
We went through exactly this with our father in law, except it was a care team telling my mother in law that because he could speak in a lucid way once every few weeks there was hope. He had very advanced cancer, and his hospice care was delayed way too long. An ER Doc that treated him for a GI bleed found out and had to be downright cruel for her to hear that hospice was necessary. His physical condition was so degraded and they weren't properly equipped to get him through the night let alone a whole weekend; the GI bleed came from her giving him handfuls of Advil for too many sources of pain to count. I don't blame her for hoping, but as much as people won't like hearing it, you aren't wrong.
I’m so sorry. I’ve seen this more times than I can count and it never gets easier but as a healthcare provider it is your job to educate families. Some doctors fail miserably at being able to do this part of their job. It’s one of the biggest things that pushed me to move from nursing to pursue medical school. Patients and families deserve better and that ER doc sounds like one of the best ones out there. It is not easy to do what he did and we need more doctors who can.
Thank you, finally a rational and logical explanation for why this is happening.
Took me a really long time scrolling through the comments to see what should be the top comment, maybe even pinned. Akin to community notes by twitter.
That said, I wish we were at this level of technology, where we could bring someone back from beyond. It’s despair inducing. I feel incredibly bad for the family.
But all I see in the comments is people just looking for a reason to hurt others, doing the unspeakable to another ceo won’t change anything, voting in the people who can change healthcare forever will. No more for profit healthcare. It’s time to tax the rich to give everyone universal healthcare.
They all own the hospitals and shit as well, probably the most corrupt system in the world including people in political positions involved. I really think they all need to put in prisons and have their assets seized to fix the system.
The US is so third world. This is so scary and dystopian. I don't get how people in the US just accept it. Why isn't it creating more Luigi's? The fact that healthcare professionals and Doctors just go along with it as well. "Ah me get no money, cannot treat" - yuck. So much for the Hippocratic oath.
Wild how some Americans are okay with this?!? and subsequently complain about Canadian and European healthcare 😭😭 are y’all alright bc wth, how do insurance people trump a medical professional judgement.
As long as Americans keep voting in anti-universal health care (Medicare for All) politicians and listen to media that calls those that are for UHC crazy radicals, this will keep happening. Conservatives will ALWAYS be against it, until it happens to them. Medicare for All will SAVE Americans money!
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