the “healthcare” industry

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  • #153712
    Avatar photozn
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    from Quora (David Marshall)

    A decade ago, I worked for UHC for about a year. The culture made me uncomfortable. I worked in claims appeals. This would entail a claim that has been denied initially when filed by the provider. It would then go to a claims adjuster to review before coming to us on appeal.

    Accuracy was stressed in training. However, once we graduated to the floor after a 6-week class (ours turned into about 8 due to holidays, etc.) It became quickly apparent that accuracy took a back seat to working claims quickly. We were given a quota to work 80 claims per day. Bonuses were awarded based on accuracy and percentage worked above the quota. Coming out of training they checked 4 claims per month for accuracy. However, once you reached quota that number dropped to 1 per month, if I remember correctly. And once you hit above a certain percentage of quota, they no longer checked claims for accuracy.

    Do you see the problem here? For someone like me who understood that the claims assigned to me represented real people’s lives, I wanted to make sure my claims were worked with the highest level of accuracy. I didn’t have a single month where I wasn’t at 100% accuracy. However, they stayed on me and some others on our team because we worked about 60–80 claims per day. That number represented us going through their Standard Operating Procedures carefully. However, we had people who regularly worked 200 or more claims per day. They knew they wouldn’t be checked for accuracy. Even worse, they were rewarded financially for working that many claims, as were the team managers and those above them. I had a colleague from class who was considered a superstar because he was hitting these crazy numbers. He told me he just denied a claim without looking at it and moved on to the next one. He also said a manager told him they only checked the claims in which we paid out.

    God knows how many claims were denied in error with this system. But, the system worked in favor of the company. Our team manager wouldn’t check this guy’s work, because it put money in his pocket, too, when he turned in 200 claims per day. Likewise, the call center managers didn’t rock the boat either because they profited from the denials.

    There is something called a corrected claim. These were claims that needed a correction, often in favor of the provider. I can’t tell you how many times UHC changed the rules for corrected claims while I was there. There was one week in which they changed the policy three times. These frequent procedural changes occurred so often to maximize the benefit in the company’s favor. Never once did the new criteria favor the providers asking to be paid.

    I was never so happy to leave a company in my life.

    #153714
    Avatar photozn
    Moderator


    .

    #153715
    Avatar photozn
    Moderator

    from Quora (Franklin Veaux)

    Why are Americans still against universal healthcare after decades of abuse from health insurance companies?

    Because they’ve had decades of slick, highly polished propaganda from insurance company marketers.

    I’ll give you an example:

    When you talk to someone who’s strongly opposed to universal health care, one of the arguments you’ll likely hear—I’ve heard this argument trotted out over and over again—is that insurance company profits are quite small, typically between 2% and 3.3%.

    That makes people believe that health insurance companies only add a tiny percentage to healthcare costs: two or three percent.

    Wrong. Wrongo Wrongo wrong wrong wrong.

    This is the Minnetonka headquarters of UnitedHealth:

    The cost of this building is not included in their profits.

    The cost of paying every person who works in this building is not included in their profits.

    The cost of the thousands of other buildings they own and the 440,000 people they employ (yes, seriously, 440,000 people) is not included in their profits.

    The cost of their investments is not included in their profits. When you send your insurance premium in, that money doesn’t sit in a bank account. The insurance companies invest it in for-profit enterprises. For example UnitedHealth is a huge landlord, with over a billion dollars’ worth of rental housing in its portfolio, administered by a large network of subsidiaries you probably have no idea are associated with a health insurer.

    In 2023, UnitedHealth posted total revenue of $371,600,000,000 and paid out $308,428,000,000 in medical claims, for a difference of $63,172,000,000.

    That’s sixty-three billion dollars just one insurance company brought in that did not go to paying for healthcare.

    So no, private for-profit insurance does not add only 2% to healthcare costs.

    But their propaganda makes it sound like it does, and a lot of Americans believe that it does.

    And that’s not even counting the ridiculous made-up horror stories about wait times and such in places with universal healthcare. Those stories are obviously absurd, but most Americans never travel abroad so they have no idea how ridiculous the lies are that they’re swallowing.

    • This reply was modified 4 days, 1 hour ago by Avatar photozn.
    #153762
    Avatar photozn
    Moderator

    from quora: Susanna Viljanen
    ·

    Why aren’t more people showing empathy towards the UnitedHealth CEO who is as murdered? Why are people defending the suspect?

    Because people in the US are sick and tired of the American profit-oriented health care and paying through the nose – and even more so with the insurance industry, which they see as a legalized racket.

    What we know is that:

    The murder is pre-meditated and definitely targeted. The murderer arrived with a bus which had left at Atlanta, GA, using a fake identity, and stayed in a hostel in NY, using another fake identity
    He prowled the victim for ten minutes before shooting.

    He used an unconventional weapon.
    The casings found at the site were signed “deny”, “defend” and “depose”, referring to a book about abuses of the insurance industry
    The murderer escaped just in a way we were taught in the military: leaving fake tracks, using multiple vehicles, using diverted routes. His tracks go cold in the Central Park.
    His backpack has been found – full of Monopoly money

    It’s been over three days now. It is likely his identity will never be resolved as the tracks have gone cold. He is most likely away from the NYC already – perhaps escaped abroad.
    What we know also is that United HealthCare (UHC) has been the most ardent insurance company to reject insurance claims, and Brian Thompson has been suspected on fraud and insider trading. He has also implemented a deeply flawed AI to handle the insurance claims.

    It is personal. My estimation is someone whose insurance claims have been rejected by UHC and who has a fatal disease – or a loved one of someone whose insurance claims have been rejected. He is not a professional, but likely to have previous gun handling experience and at least rudimentary experience on guerrilla warfare tactics. He has a sick sense of humour (the signed cartridges, the backpack full of Monopoly money) and he wanted to mock and harass both the medical insurance industry and NYPD. It is likely we will see similar antics in the next days.

    I do not think the case is about a triangle drama – or a competiting insurance company. It may also be the murderer is a disgruntled employee of the UHC – someone thoroughly morally disgusted on being a part of what they see as a legalized racket. Who might want Thompson dead?

    Anyone, who or whose loved one has died, become moribund, or left permanently crippled, or gone bankrupt due to rejected insurance claims. Any corporate employee, who is disgusted on working in a racket not unlike Mafia. Anyone, who is sick and tired by being screwed by the profit-oriented medical care and the legalized fraud of the insurance industry. Anyone, who has medical debt. Anyone forced to pay 10 to 100 times more of medicines than EU citizens – and does not have an access to Mexico or Canada for medicines. Anyone with a pre-existing condition. If we narrow down only to those whose claims have been turned down by UHC, we can narrow the pool of suspects down to 8.1 million people.

    NYPD initially offered a 10,000 USD reward for any clues leading to apprehension. Now the reward has been raised to 50,000 USD – but the posters have been defaced and torn off. Seemingly the New Yorkers do not want the murderer to get caught.

    Brian Thompson is seen as the bad guy. He implemented a deeply flawed AI to handle the insurance claims, rejecting one third of the claims, and it was found the AI got wrong in 90% of the cases.

    But even worse and more unethical was found. The AI was found to be optimized to find cases where the company would gain the biggest profits by denying the claims and where the patient would be too weak to protest and raise a lawsuit against the company, and where actual immoral practices would produce an arbitrage. AI actually kills people. Brian Thompson has been seen as the guy who presses that black button which kills someone – and brings him million dollars.

    Physical violence is the last resort of the poor and the downtrodden, and in a country so immersed in firearms, something like this was bound to happen sooner or later. It happened sooner. I sincerely hope we will learn something from this.

    The murderer is now fifth day on the loose. Each day means diminishing chances of him ever getting caught. It is likely he has already escaped the country and is out of the reach of justice – many countries refuse to cede wanted criminals in countries which have death penalty. Some 50% of all murders in the US go unsolved anyway.

    #153772
    Avatar photowv
    Participant

    They caught him, i see. Sigh.

    A tweet, i read:

    “Wild that the McDonald’s employee who snitched on Luigi Mangione probably can’t even afford healthcare.”

    w
    v

    #153816
    Mackeyser
    Moderator

    I don’t believe they got the guy.

    You don’t grow a unibrow in a day.

    As mentioned in Minority Report, you never find an orgy of evidence.

    He’s in so much pain he has to kill the CEO of United Healthcare, but he sits on a bus from Georgia and lays in wait? Has no one who set this up ever ridden a bus for more than an hour?

    He’s pissed and goes out of his way to hide his identity and not be caught on camera using multiple fake identities (the guy used to lead an AI undergrad group at Stanford), but he takes off his mask and flirts with a McDonalds employee AFTER photos are released to the media?

    Either he’s the stupidest smart guy in America who can flirt while in immense pain or this is all bullshit.

    I’m going with bullshit.

    Sports is the crucible of human virtue. The distillate remains are human vice.

    #153822
    Avatar photozn
    Moderator

    #153838
    Avatar photoZooey
    Moderator

    And that’s not even counting the ridiculous made-up horror stories about wait times and such in places with universal healthcare.

    And ignores wait times here. My hernia surgery was approved in April, and I waited until in late October for the procedure. Just saying.

    something like this was bound to happen sooner or later. It happened sooner.

    I’d say later, myself. But I’m the guy who, in the 80s, said the easiest way to inflict a bunch of terrorist damage would be to fly a plane into a target building. So maybe I’m just an unfulfilled and gifted criminal mastermind.

    If they indeed have the actual guy, he was either resigned to getting caught, or intended to get caught from the beginning. I guess there is more to the story, but it sure seems strange that he did everything professionally…except dispose of incriminating evidence – you know – the MOST obvious precaution any moron criminal would do. More to come, I guess.

    #153839
    Avatar photowv
    Participant

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