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UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

propublica.org

121–130 of 394 posts

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#121

The events of the last week are just what happens when a company decides to refuse to meet its customers in the marketplace of sane ideas. You could probably have gotten away with what UNH did if the money wasn't so ridiculous. Thompson himself had a compensation package worth $10.2 million[0] a year. It's reasonable to think that other c-suiters at the company, along with those of its parent organization, made simil…

[deleted]

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#122
post #99

Earlier quoted context omitted.

I had to get a medication for a stomach bacteria called C. diff. It has bad relapse rates and its best to get it in check asap. What my doctor prescibed was the newest/best antibiotic for the issue, the other have worse recovery rates and way worse side effects. I have very good insurance. The price of the medication without insurance was about $5000, the price with very good insurance was about $1300. After redditin…

Well of course. In the USA, health insurance is legally required to spend at least 80% of premiums on medical care [1]. So, if they paid for only 50$ of care, they would only be able to make at most 62.50$ of revenue. The only way to keep revenue and total profits increasing is to increase costs. [1] https://www.healthcare.gov/health-care-law-protections/rate-...

The insurance still paid the $3700 or so, the rebate coupon is to remove the obstacle for the patient so that the larger payment gets made.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#123
post #99

Earlier quoted context omitted.

I had to get a medication for a stomach bacteria called C. diff. It has bad relapse rates and its best to get it in check asap. What my doctor prescibed was the newest/best antibiotic for the issue, the other have worse recovery rates and way worse side effects. I have very good insurance. The price of the medication without insurance was about $5000, the price with very good insurance was about $1300. After redditin…

Well of course. In the USA, health insurance is legally required to spend at least 80% of premiums on medical care [1]. So, if they paid for only 50$ of care, they would only be able to make at most 62.50$ of revenue. The only way to keep revenue and total profits increasing is to increase costs. [1] https://www.healthcare.gov/health-care-law-protections/rate-...

That’s a really important point. All the incentives are to increase cost.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#124
post #32

Earlier quoted context omitted.

And all it takes is one juror being inflexible.

That's all it takes for a hung jury, yes. In which case the prosecution will have plenty of grounds to screen for that in the next trial, that next trial will happen, and then the guy gets convicted of first degree murder. Presuming he's found in the first place. There's no world in which all twelve jurors vote not guilty if the defendant is demonstrated to be the assassin beyond reasonable doubt. That simply won't h…

The deep south was infamous for simply not convicting white men for killing black men that had "raped" white women.

No matter the evidence.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#125

I really don’t get why everyone involved is allowed to have hidden prices. It looks like a highway robbery. I had a relative visiting from Europe and they had to go to the urgent care for some blood and urine tests and consultation. They received a $2,500 bill! My relative told the hospital that they are leaving the country and offered to pay $250 or good luck collecting from abroad. Then something magical happened.…

Technically speaking, there's supposed to be an available price sheet of services posted somewhere where patients can find it. IIRC this was a law passed during the first Trump administration. The way that healthcare companies have been dealing with this is to post indecipherable price lists in a place that's buried within their websites. [0] [0] https://arstechnica.com/science/2019/01/new-hospital-price-l...

That doesn't help, because it doesn't tell you what insurance will or will not cover

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#126
post #11

Horrifying. But also horrifying that treatment costs so much. Supposedly we have to let drug companies charge extravagant prices because it costs so much to discover new treatments, but there has to be a great deal of inefficiency there. Are we getting a 99% solution for $X when we could be getting a 95% solution for $X/10?

>But also horrifying that treatment costs so much. My mother underwent chemotherapy for her cancer. According to the statements from her insurance company, each round of chemotherapy cost as much as a new luxury car before hospital vs. insurance negotiations. Yeah. The value of health insurance isn't just the offloading of expenses, it's also their power to tell hospitals to get fucking bent with ludicrous bills.

The health industry is what's wrong with a captured market and few players. Every party is trying to extract maximum value for minimum input.

That leads hospitals to 1000x every treatment price so when insurance companies come to negotiate they can negotiate down to 100x. It causes hospitals to understaff because is cheaper to pay for legal staff to handle malpractice claims than it is to not work your nurses and doctors to death.

It causes drug companies consolidate and then charge through the nose for drugs that cost them pennies to manufacturer (for example, penicillin or insulin) drugs that, everyone should be aware, all of the R&D and FDA approval has been done. The most expensive part of drug development is done.

There are solutions. It's regulations. Hospitals regulated to minimal coverage. Drug/hospitals hit with anti price gouging regulations. Insurance companies hit with coverage regulations.

That's all something doable and probably with enough political will to be done.

An even better idea is simply nationalizing medicine, top to bottom. That's unlikely to happen, but would result in the biggest drop in healthcare costs.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#127

I really don’t get why everyone involved is allowed to have hidden prices. It looks like a highway robbery. I had a relative visiting from Europe and they had to go to the urgent care for some blood and urine tests and consultation. They received a $2,500 bill! My relative told the hospital that they are leaving the country and offered to pay $250 or good luck collecting from abroad. Then something magical happened.…

I'm type 1 diabetic, so I have a lot of medical costs. I'm legitimately traumatized by decades of navigating the US healthcare system, and one of the biggest problems is never having a real idea what things are going to cost, what will be covered, or when my insurance will randomly stop covering one of my medications, or take one of my doctors out of network.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#128
post #80

Earlier quoted context omitted.

I needed an adrenalectomy. I called before hand, trying to figure out what I would owe afterwards. No one could give me a price. It’s all vague, we don’t know answers. It’s absurd. I basically got stern - eventually somebody is going to send me a bill with a number on it, so someone knows what this will cost. Still never got a solid number out of them.

Even better, the hospital might use subcontractors for some services so for months you will be getting bills from random vendors. In any case, best of luck with your surgery:)

My ex had surgery years ago. The hospital messed up something with billing so she had to go to 20 different companies to make them redo their bills. Took a year of almost full time work.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#129

Earlier quoted context omitted.

Ghoulish? Internet? Have you spoken to regular people not terminally online? They have no sympathy for the CEO. I had sympathy for him as a human and a worker, but his behavior was beyond the pale and unfortunately rule of law doesn’t exist in the US.

> Have you spoken to regular people not terminally online? They have no sympathy for the CEO Everyone I have spoken to has no sympathy for him as a CEO but sympathy for him as a human. He is wrong and the healthcare system is broken. But this was also murder. If your sense of empathy is so fucked that you’re pro murder, you need to speak to a professional. (If you’re struggling with this and don’t want to let hate tu…

I don't know a single real person who felt bad for him.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#130
post #74
post #26

Earlier quoted context omitted.

I'm also a New Yorker and I think that most of us actually do not believe that assassinations are a net benefit to society, no matter how dissatisfied with the health care system we are.

It was actually a pretty large net positive. Anthem immediately reversed their decision to cap anesthesiology coverage: https://www.wfsb.com/2024/12/05/anthem-backtracks-anesthesio...

I'm not an expert, but this piece on Vox doesn't take that move as a positive: https://www.vox.com/policy/390031/anthem-blue-cross-blue-shi...
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