UnitedHealth Group, the largest US healthcare insurance company, has these lovely sentiments to share on behalf of their beloved bygone billionaire:
https://www.nytimes.com/2024/12/13/opinion/united-health-care-brian-thompson-luigi-mangione.html
Excerpts:
We greatly appreciate the enormous outpouring of support for Brian, who ran our health insurance business, UnitedHealthcare...Yet we also are struggling to make sense of this unconscionable act and the vitriol that has been directed at our colleagues who have been barraged by threats.
We know the health system does not work as well as it should, and we understand people’s frustrations with it. No one would design a system like the one we have. And no one did. It’s a patchwork built over decades. Our mission is to help make it work better. We are willing to partner with anyone, as we always have — health care providers, employers, patients, pharmaceutical companies, governments and others — to find ways to deliver high-quality care and lower costs.
Clearly, we are not there yet. We understand and share the desire to build a health care system that works better for everyone. That is the purpose of our organization...
...While the health system is not perfect, every corner of it is filled with people who try to do their best for those they serve.
When a colleague proposed a new idea to Brian, he would always ask, “Would you want this for your own family?” If not, end of discussion...
...The ideas he advocated were aimed at making health care more affordable, more transparent, more intuitive, more compassionate — and more human.
And then there is the reality of the matter. One tiny sliver of this reality:
https://www.propublica.org/article/unitedhealthcare-insurance-autism-denials-applied-behavior-analysis-medicaid
Excerpts:
Benji was nearly 3 when he was diagnosed with severe autism and soon after started a specialized therapy to help him develop basic skills. After two years in treatment, his murmuring gave way to small words...
Menard, who is raising Benji alone in south-central Louisiana, began to picture a future for her son that diverged from the stories she’d heard about some kids with similar diagnoses, who grew up still unable to manage their frustrations and had to live in nursing homes or institutions.
But now, she’s worried again.
The insurer that has been paying for her son’s therapy, UnitedHealthcare, has begun — to the befuddlement of his clinical team — denying him the hours they say he requires to maintain his progress. Inside the insurance conglomerate, the nation’s largest and most profitable, the slashing of care to children like Benji does have a reason, though it has little to do with their needs. It is part of a secret internal cost-cutting campaign that targets a growing financial burden for the company: the treatment of thousands of children with autism across the country.
ProPublica has obtained what is effectively the company’s strategic playbook, developed by Optum, the division that manages mental health benefits for United. In internal reports, the company acknowledges that the therapy, called applied behavior analysis, is the “evidence-based gold standard treatment for those with medically necessary needs.” But the company’s costs have climbed as the number of children diagnosed with autism has ballooned...
...So Optum is “pursuing market-specific action plans” to limit children’s access to the treatment, the reports said.
“Key opportunities” are outlined in bullets in the documents. While acknowledging some areas have “very long waitlists” for the therapy, the company said it aims to “prevent new providers from joining the network” and “terminate” existing ones, including “cost outliers.” If an insurer drops a provider from its network, patients may have to find a new clinician that accepts their insurance or pay up to tens of thousands of dollars a year out of pocket for the therapy...
...The strategy targets kids covered through the company’s state-contracted Medicaid plans, funded by the government for the nation’s poorest and most vulnerable patients... When companies spend less than the allotted payment, they are typically allowed to keep some or all of what remains, which federal investigators and experts acknowledge may be incentivizing insurers to limit care....
...So Optum — whose parent company, UnitedHealth Group, earned $22 billion in net profits last year — is “heavily investing” in its plan to save millions by limiting access to such care.
In addition to culling providers from its network, the company is scrutinizing the medical necessity of the therapy for individual patients with “rigorous” clinical reviews, which can lead to denials of covered treatment. Optum has developed an “approach to authorizing less units than requested,” the records state.
Mental health and autism experts and advocates reviewed ProPublica’s findings and expressed outrage over the company’s strategy. Karen Fessel, whose Mental Health and Autism Insurance Project helps families access care, called the tactics “unconscionable and immoral.”...
...Benji, who is now 10, requires 33 hours of weekly therapy to be able to progress, his therapists have concluded. They have documented the consequences of having even a few hours less: toppled furniture, scratched-up classroom aides, a kid in unremitting tears, unable to learn. But in a letter to Menard, Optum said it was refusing to pay for the full hours, stating that her son had been in therapy for too long and was not showing enough progress to ultimately graduate from it.
“Your child still has a lot of difficulty with all autism-related needs,” Optum wrote. “Your child still needs help, but it does not appear that your child will improve enough to end ABA.”
The response confounded experts who spoke with ProPublica, who said such an approach misunderstands the long-term nature of his condition. “Challenges that often come with autism shouldn’t be looked at like an injury that you’re going to get better from quickly and then the treatment can stop,” said Christa Stevens, who directs state government affairs for the advocacy group Autism Speaks. “Treatment may still be medically necessary even if it’s for skill maintenance or the prevention of regression.”
The company’s denial also appears to contrast with recent professional guidelines for the therapy — which are cited as a reference in Optum’s own clinical criteria — that state “there is no specific limit on the duration of a course of treatment.”
The appropriate duration of treatment, according to those standards and experts interviewed by ProPublica, should be based on the patients’ needs, as evaluated by the clinicians working directly with the patients.
Several advocates told ProPublica the company’s strategy is legally questionable.
The federal mental health parity law requires insurers to provide the same access to mental health and physical care. As ProPublica recently reported, United has gotten in trouble in the past for targeting therapy coverage in a way that violates the law; while denying the allegations, it agreed to a multimillion-dollar settlement. It continues to use arbitrary and one-size-fits-all thresholds to scrutinize its therapy claims, ProPublica previously found...
...Optum is focusing on states whose Medicaid plans yield the highest costs for ABA therapy, including Arizona, Nebraska, Tennessee, Virginia, New Jersey, Indiana and Louisiana, where Menard and her son live...
...Autism experts said such a strategy may not only be harmful to children, it could also ultimately be more expensive for states, as children age and require more intensive services, like residential or nursing care.
There is much more to the ProPublica article, including images of the receipts that back it up. But the jackals bark and howl and yip: "Yet we also are struggling to make sense of this unconscionable act and the vitriol that has been directed at our colleagues who have been barraged by threats."
Struggling to make sense of it? Really, pigs? And meanwhile, $22 billion dollars in profits last year alone!
@Soothfast saidDespicable is the only word I can think of to describe this.
UnitedHealth Group, the largest US healthcare insurance company, has these lovely sentiments to share on behalf of their beloved bygone billionaire:
https://www.nytimes.com/2024/12/13/opinion/united-health-care-brian-thompson-luigi-mangione.html
Excerpts: [quote]We greatly appreciate the enormous outpouring of support for Brian, who ran our health insurance business, ...[text shortened]... to make sense of it? Really, pigs? And meanwhile, $22 billion dollars in profits last year alone!
3 edits
@Soothfast said"We understand and share the desire to build a health care system that works better for everyone. That is the purpose of our organization..."
UnitedHealth Group, the largest US healthcare insurance company, has these lovely sentiments to share on behalf of their beloved bygone billionaire:
https://www.nytimes.com/2024/12/13/opinion/united-health-care-brian-thompson-luigi-mangione.html
Excerpts: [quote]We greatly appreciate the enormous outpouring of support for Brian, who ran our health insurance business, ...[text shortened]... to make sense of it? Really, pigs? And meanwhile, $22 billion dollars in profits last year alone!
This is the biggest pack of lies I've ever heard! As a medical biller, I'm on hold with UHC an average of 35 min. several times a week simply to get information on why claims were not paid, only to find out they never bothered to process them once they were sent. Only after I call them, do they bother to do so. Their customer service people (located in the Philippines) speak poor English and often must refer me to supervisors simply to communicate.
Good news for me - I'm racking up lots of billable hours this way, but it's costing UHC's customers and participating providers a bundle.
United Health Care has had many years and nearly unlimited resources to fix its disorganized structure, long telephone hold times for users and medicals providers, and denied medical claims (often for no good reason) and they've made no progress whatsoever.
- United Health Care IS The Problem!!
@Soothfast saidis this the same propublica that just got caught trying to lie about Pete Hegseth?
UnitedHealth Group, the largest US healthcare insurance company, has these lovely sentiments to share on behalf of their beloved bygone billionaire:
https://www.nytimes.com/2024/12/13/opinion/united-health-care-brian-thompson-luigi-mangione.html
Excerpts: [quote]We greatly appreciate the enormous outpouring of support for Brian, who ran our health insurance business, ...[text shortened]... to make sense of it? Really, pigs? And meanwhile, $22 billion dollars in profits last year alone!
@mchill saidwho is forced to have united health care insurance?
"We understand and share the desire to build a health care system that works better for everyone. That is the purpose of our organization..."
This is the biggest pack of lies I've ever heard! As a medical biller, I'm on hold with UHC an average of 35 min. several times a week simply to get information on why claims were not paid, only to find out they never bothered t ...[text shortened]... r no good reason) and they've made no progress whatsoever.
- United Health Care IS The Problem!!
If anything you are demonstrating the failure of "obamacare"
@mchill saidWe can be more exact: UHC is the manifestation of the problem. 😆
- United Health Care IS The Problem!!
THE actual problem is strictly regulating a healthcare "market" to reduce competition to near zero but then refusing to regulate the resulting soar in prices.
Europe regulates both competition AND prices which turns healthcare into a public utility - which doesn't lead to much innovation, but it functions.
A few countries regulate very little and get all the benefits of a completely free market in healthcare. Thailand comes to mind, at least that was true when I traveled there.
The US has taken the worst of both approaches. Highly restricted competition, but ZERO regulation of prices.
It's like offering water companies a monopoly and then having people buy "insurance" so they can pay for the water they use. It's bananas. But it is why we have the highest healthcare costs in the world. 😆
@Mott-The-Hoople saidSomeone on Medicaid who finds that their healthcare is to be mediated by UHC, that's who. No choice there, except to go without and maybe die.
who is forced to have united health care insurance?
If anything you are demonstrating the failure of "obamacare"
It certainly demonstrates the failure of having a conglomerate of privateers acting as middlemen between patients and Medicaid. "Obamacare" is a poor compromise, but it's better than what existed before. The fact that a far smaller fraction of the population remains without coverage compared to the beforetimes demonstrates this. The fact that people cannot be denied coverage for having a preexisting condition also demonstrates this.
@Soothfast saidDo your homework. There are actually fraudsters out there.
Someone on Medicaid who finds that their healthcare is to be mediated by UHC, that's who. No choice there, except to go without and maybe die.
It certainly demonstrates the failure of having a conglomerate of privateers acting as middlemen between patients and Medicaid. "Obamacare" is a poor compromise, but it's better than what existed before. The fact that a far smal ...[text shortened]... act that people cannot be denied coverage for having a preexisting condition also demonstrates this.
The responses from the right-wingers here certainly show that Trumpers and the GOP do not really care about the same things that the vast majority of ordinary Americans care about in their everyday lives.
Here's the reality: more than 70% of Americans feel the healthcare system is failing them according to a Harris poll (no, not that Harris):
https://time.com/6279937/us-health-care-system-attitudes/
Last month Gallup found that 62% of Americans "think it is the responsibility of the federal government to make sure all Americans have healthcare coverage." Only 36% think otherwise.
https://news.gallup.com/poll/4708/healthcare-system.aspx
Another Gallup poll a little earlier found that fully 70% think the US healthcare system either has major problems or is in crisis, as pertains accessibility and affordability.
So, there is real anxiety, pain, and concern out there, and Republicans are really not interested in hearing about it. They cavalierly dismiss the chaos and misery as being just so much noise. For Republicans, having fifty people denied essential medical care to possibly catch one person committing "fraud" is a great bargain, even when factoring in the billions of dollars in expenses incurred to maintain massive state bureaucracies whose sole job is to harass and hamstring Medicaid recipients "just in case" someone out there is getting a pill or tonic to which an accountant believes they are not entitled. This is the Republican mind's conception of justice, apparently.
@Soothfast saidThere is nothing in the constitution requiring the government to be sure that everyone has healthcare. So you are wrong right out of the gate. You just say that like it is the gospel. The gospel is what the law is. Right now, we are basically responsible for our own medical coverage. Yes, there are emergency rooms and care for the indigent, and of course free healthcare for illegal Americans that crashed our border, but I am speaking about basically waking up in the morning as a normal American being sure that you have insurance before you step out on the day. That is the only process fir someone to have his healthcare covered.
The responses from the right-wingers here certainly show that Trumpers and the GOP do not really care about the same things that the vast majority of ordinary Americans care about in their everyday lives.
Here's the reality: more than 70% of Americans feel the healthcare system is failing them according to a Harris poll (no, not that Harris):
https://time.com/6279937 ...[text shortened]... nt believes they are not entitled. This is the Republican mind's conception of justice, apparently.
Then you say something about what everybody wants to have. I guess you should start another thread on that. Some people like me do not think that the government should be responsible for everyone’s healthcare. So yes, why don’t you start a thread on that,,,, that would be interesting to get your reasoning on that. It’s like I would have to pay for your Healthcare. Does that sound right to you?
@AverageJoe1
You say that Republicans are not concerned or interested? Do you know that Republicans make more charitable contributions than do Democrats? So here again, you are wrong right out of the Gate