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U.S. opens UnitedHealth antitrust probe

525 points by moose_man 3y ago

boringuser2 3y ago
Healthcare in the US is just another face of why the US is an economy and not a country.
aquaphile 3y ago
Finally! Now do the Blues (please, please DOJ and FTC). And the major inpatient and provider oligopolies. Market concentration across many layers is a huge reason we spend 17% of US GDP on healthcare.
- anotheruser13 3y ago
  And all the private equity firms that created some of these monsters.
moose_man 3y ago
https://archive.ph/meOGZ https://archive.ph/meOGZ
stop50 3y ago
I sense a new glauckomflecken video.
- LordDragonfang 3y ago
  My first thought as well. Everything I know about UH and Optum (all of it negative) come from his videos, and it makes me appalled that any company like this is allowed to exist, when every study seems to indicate that patient in private-equity-owned care experience worse, more expensive care. It's the opposite of "capitalism creating efficiency".
  - NickC25 3y ago
    >opposite of "capitalism creating efficiency" It's rent seeking behavior by an actor that pretty much is a negative value-add from a patient's perspective. They are a cancer.
  - stop50 3y ago
    Its my primary source of Schadenfreude, because whenever he says anything about insurance covering, i usually research it and come up with that it is covered.
    - LordDragonfang 3y ago
      Covered according to what source? The ones the insurances provide? Because the single most frequent complaint I hear about insurance is them deciding that something which they claim to cover, and should cover, they're suddenly no longer going to pay for because of some bullshit excuse. It's one of the reasons doctors have to waste hours of their time every week getting "prior authorizations" for things the insurance claims they will cover.
      - stop50 3y ago
        They are legally Required to cover it. An council checks every new drug if it helps and if the price is appropiate. That is done for each drug indipendent of the regulation of the drug. the insurance has very few things to deny an claim(in most cases they deny them because an doctor abbreviated his/her title, but due an new method to transport the receipts its very probably that the number will drop) and none if the doctor deems it absolutly nessesary.
- athenot 3y ago
  For those not familiar, here is the one on Optum & United Healthcare: https://www.youtube.com/watch?v=_khH6pZnHCM https://www.youtube.com/watch?v=_khH6pZnHCM
  - John23832 3y ago
    “Jimothy, when you make enough money, you get to write the laws.”
mindslight 3y ago
How is there an argument of wrongdoing here when the regulatory approach for healthcare is still based around this idea that multiple anticompetitive arrangements (the price fixing between providers and "insurers") will somehow actually create competition? Like don't providers have to be standing alone as their own market independent of payer before one could say that UHC's actions here are specifically anti-competitive, rather than just the HMO system working as envisioned?
throwway120385 3y ago
Given the way United Healthcare is organized, with Optum as a second party that all claims or other billing issues is directed to, this allows them to very effectively point the finger at each other whenever there is a dispute. Optum in turn owns a lot of care providers including a ton of providers in my area. They have used this as a cudgel in the past, as someone I know was slammed with a bill during Optum's takeover of one of their providers. The Optum employee wouldn't provide any information about the charge and simply fired them as a patient for not paying it. Because Optum is buying up clinics left and right where we live this person has lost access to their PCP on multiple occasions as Optum buys more and more healthcare groups. UHC and UnitedHealth group need to be broken up, and these incestuous relationships between insurance companies, private equity companies, and care providers need to be stopped by the SEC, because their only purpose is to exploit the wrapping up of care providers under one umbrella to extract more money for less work from people seeking essential services.
- datavirtue 3y ago
  Sounds like the pitch to investors.
- kurthr 3y ago
  They key point is that healthcare insurers, pharmacy benefit managers, pharmacies, and healthcare groups are all owned by one holding company which benefits when prices go up. People think that the insurer will try to keep costs down, but in fact, if prices go up they can charge more for insurance... the only way they can keep increasing shareholder value is for prices to go up. So they do, and by owning the entire chain they can force that to happen. There is no market. Insurers will not negotiate prices lower, it is against their interests!
  - throwway120385 3y ago
    In Optum/UHC's specific case, I can give an example of this from using their IVF benefits. In one plan we had from them my partner was entitled to 10k for treatment and 15k for medications. Optum Specialty Pharmacy was the only in-network pharmacy for the IVF drugs. When we started ordering IVF medications under insurance, we found out that the price the pharmacy charged insurance was over 3x what their cash price was for nearly everything. We ran out of the 15k in a single retrieval cycle because of this, and wound up with a bill to the tune of several thousand dollars because one specific prescription ended up partially billing to insurance. People often lose sight of the fact that when you bill insurance, even if the item is only partially covered, the charge you must pay is the insurance negotiated rate even if the insurance is capped well below the price of the charge. We concluded that the medication benefit was a huge racket because of this, and I would imagine Optum rakes in thousands of dollars per patient on something that according to the policy documents is fully covered. Meanwhile other nationwide pharmacies like Alto Pharmacy do offer the drugs at very reasonable prices, often 1/5 to 1/10 what Optum was charging.
NickC25 3y ago
>UnitedHealth executives have said that Optum and UnitedHealthcare don’t favor one another Yeah, that's laugh-out-loud levels of bullshit. You think executives are just going to admit to facilitating what effectively is a form of racketeering? NINJA EDIT: The Optum arm itself needs to be broken up into a bunch of smaller pieces. United Healthcare also needs to be broken up.
- Auracle 3y ago
  That's insane. The archive link isn't working for me so I can't read the article, but we received a letter that any long term prescriptions might need to go through Optum and that we'd only be able to fill a few at a local pharmacy before the refused to cover them. I was a bit flabbergasted as that didn't seem like it could possibly be legal. By the way - that's absolutely not great if you have controlled medications, as you need to sign for them and can't exactly get them filled early. I take three different ones. Luckily my wife and I work from home.
  - justinclift 3y ago
    > The archive link isn't working for me ... For me, that link bounces to the archive.md version of it (same url, but archive.md domain), which is resolving to 139.99.171.251. You can probably get it to work by adding an override in your /etc/hosts (or equivalent) file, and using the archive.md version of the url. In theory. ;)
bearjaws 3y ago
Go after all the healthcare giants. If people knew even half of how consolidated their treatment was, they would riot. For those who don't know about the significant conflict of interest present here: 1. United is a health insurer that has to make payments for people's 2. United owns several physician networks (totaling 90,000 physicians), who then determine what your care should be—no conflict with the fact that they pay the bills... 3. United owns Optum, which determines how much your drugs are going to cost, and of course, who makes them—brand vs. generic, etc. 4. Optum runs its own mail order and specialty pharmacies. Optum also writes your care plans for many chronic diseases and ships medications all over the country. 5. Optum could require their own customers to use their care plans and software in order to receive medications at all, or mark up the price for anyone who doesn't. Let's step through a workflow. You, a patient on United, go to a physician for treatment. Later on, you get referred to a specialist, then get diagnosed with a chronic disease and need medication that you receive delivered monthly. That pans out to: United pays United, who refers you to United, that forwards you to Optum (owned by United), who gets paid by United. Each and every month. Let's say you find a better deal for your medication at another pharmacy. Too bad, its not going to be in your network and Optum will no longer cover it. How is a health system or an independent supposed to compete with that level of integration? This, of course, does not result in any savings or quality of life improvement for the patient or the physician. United and Optum charge the same prices as everyone else, or more.
- yborg 3y ago
  You didn't even mention Optum Bank, which they use to also sponge up that sweet HSA cash lest any drop of healthcare spend somehow escape UHG's toll.
- sensanaty 3y ago
  Imagine if the useless governments actually broke up these behemoth megacorporations that control the entire vertical and horizontal slice of industry they operate in. What a crazy concept, right?
- rapatel0 3y ago
  > 2. United owns several physician networks (totaling 90,000 physicians), who then determine what your care should be—no conflict with the fact that they pay the bills... I disagree that this is necessarily a bad thing. One of the critical problems with our current model is the Fee-For-Service. When the insurance company is separate from the payer, then the incentive is to treat patients like revenue. A significant part of our ballooning costs are due to this fundamental miss-incentive. When the payer and provider are the same entity, that is the one of the only effective mechanisms to control costs. I've thought about this a lot and I think that there are 3 critical changes that would fix the whole fucking thing: - Insurance being one country scale pool of capital - Actually average out the risk across lifetime - Every provider must be the payor - Incentivize hospitals to manage costs - Individual vouchers to join a network - Give the patient agency to join a care network that manages their health well.
ChrisArchitect 3y ago
Related: US pharmacy outage triggered by 'Blackcat' ransomware at UnitedHealth unit, sources say https://www.reuters.com/technology/cybersecurity/cyber-security-outage-change-healthcare-continues-sixth-straight-day-2024-02-26/ https://www.reuters.com/technology/cybersecurity/cyber-secur... (https://news.ycombinator.com/item?id=39524514 https://news.ycombinator.com/item?id=39524514)
Blackthorn 3y ago
Optum is the most garbage organization that has absolutely ruined local healthcare. I go out of my way to find places that aren't affiliated, even though they're much further distance, just to avoid them. It's about time this happened.
dandigangi 3y ago
Do Discover/Capital One next.
codegeek 3y ago
All health insurance companies need to die. They are all crooks and frauds and are using an outdated system in our country siphoning money from families.
- Spivak 3y ago
  This opinion isn't actually all that drastic. If we just got people on the HSA + disaster coverage* train a lot of the issues with the system would disappear. I am far far from the cheapest patient but my annual spending doesn't even get to 50% of my portion of the premiums of my employer's PPO plan. * Where if a doc prescribes insurance pays for it no questions asked (to you the patient). They can claw it back from the doctor if they think it's excessive. I think for disaster only coverage you could successfully pass laws to this effect without insurance companies starting a third world war.
  - wildrhythms 3y ago
    Why would your ideal solution still involve insurance? I think most people want the hospital (they don't care who runs it) to send the bill to the government. That's it. And if the state or federal government wants to set up a system of oversight over the charges, then good.
    - lotsofpulp 3y ago
      > And if the state or federal government wants to set up a system of oversight over the charges, then good. That is what happens now. See Medicare/Medicaid/Tricare/federal government employee plans/etc. That is why health insurance companies are better referred to as “managed care organizations” (MCOs). Most importantly, they are selling a plausible deniability shield to government leaders. The government is paying for healthcare, but since there is insufficient supply of healthcare, someone has to get shafted. Using the MCOs to do it lets government leaders point fingers.
- SlightlyLeftPad 3y ago
  A-f**ing-men
FireBeyond 3y ago
My "favorite" story about UHC is from a provider perspective. Taking a page from Section U in The Rainmaker ("deny all claims"), they went through a phase where multiple people took them to court over HEMS (helicopter EMS) transport denials, including from the scene of serious car accidents, due to lack of "pre-authorization". Apparently in their mind, us paramedics (or maybe the chopper pilot) should have been calling their 800 number as we stabilized our patient... "This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the hospital due to extensive multisystem trauma but we need a pre-auth. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, I know, I know, sorry, it's a bit loud with the jaws of life and the engines... What's that? Um, sure, yes, I can hold for a nurse consult..."
voakbasda 3y ago
UnitedHealth is by far the worst health coverage I have ever had. They are so bad at paying claims that our local hospital network has dropped them; all of our emergency care in the immediate region is now out-of-network. They absolutely are criminals and deserve to be put out of business.
- earthwalker99 3y ago
  A friend of mine couldn't get his claims paid even as a UHC corporate employee. He ended up quitting his job at a health insurance company because he wanted functional health insurance.
rainbowzootsuit 3y ago
Not shilling here, merely impressed by the work of journalist Marshall Allen—he has a book "Never Pay the First Bill". Search around on podcasts and YouTube for some interviews to get the jist. I've bought a few copies for friends that had expensive health issues and have used the techniques on relatively small stuff for myself.
camhart 3y ago
We signed up for a United Healthcare plan a couple years back. It showed a bunch of Doctors in network. Once we were on the plan, 90%+ of the Doctors told us they didn't accept United Healthcare or weren't accepting new patients. We couldn't find quality Doctors near us as a result. Ended up having to switch off United Healthcares plan as a result. Certainly felt like it was false advertising to say all the Dr's are in network just to find out none of them will treat you.
- burkaman 3y ago
  It is absolutely false advertising and probably illegal, and it's not just you: https://jacobin.com/2024/01/health-insurance-giants-companies-unitedhealthcare-directory-in-network-providers https://jacobin.com/2024/01/health-insurance-giants-companie.... There has been some congressional interest (https://www.finance.senate.gov/chairmans-news/wyden-calls-for-action-to-get-rid-of-ghost-networks-releases-secret-shopper-study https://www.finance.senate.gov/chairmans-news/wyden-calls-fo...) but I think it would take a big class action lawsuit or something to "fix" this. Obviously the only actual fix is universal coverage though.
Wh1skey 3y ago
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sabujp 3y ago
There's also this : https://www.reuters.com/technology/cybersecurity/cyber-security-outage-change-healthcare-continues-sixth-straight-day-2024-02-26/ https://www.reuters.com/technology/cybersecurity/cyber-secur... , this hack caused by malware from 2021, caused huge portions of their employee base tied to optum and their change healthcare acquisitions to be unable to work for days (and it's still ongoing!). I guess their employees got a "vacation" out of it while everyone else waiting on prescriptions at CVS, etc got shafted. It literally took a huge portion of the US pharmacy network to go down for the US to realize what a big problem UNH is.
- bithead 3y ago
  Former Optum/UHG employee, worked in automating things in IT. While I was there they went on a years long spree to get rid of everyone under 40. I finally got laid off and in my group of 153, 17 were under 40. I had automated most everything in my area,and although I meticulously documented everything, when you get the plug pulled like that you don't get time to do any hand off, so it hit things pretty hard. They did this for months (laying off people under 40). They gave me a large enough severance to cover a long time out of work, and the severance agreement stated if I sued for EIRSA I had to pay it back. I took it, but the entire thing painted a picture of management totally disconnected from the people putting code to programs.
roberttod 3y ago
All the awful reviews of united here, and yet it's reviewed as one of the highest rated insurance agencies (for example see https://www.forbes.com/advisor/health-insurance/best-health-insurance-companies/ https://www.forbes.com/advisor/health-insurance/best-health-...) Are these reviews completely paid for? What's going on here? Or are all the options awful. I am in the position to choose our provider at our (small) company, but between Gusto and JustWorks and the majority of our employees being in Texas there was slim to none options except united.
- jjulius 3y ago
  The criteria that your Forbes piece judges UHC on don't seem to be the things that people are complaining about. Seems that the Forbes piece is more of a surface-level judgement than anything.
- SlightlyLeftPad 3y ago
  Yes
- burkaman 3y ago
  All the options are awful. Obama got in trouble for saying "if you like your plan you can keep it" when promoting the Affordable Care Act, because it wasn't true, but in some sense it was true because I truly cannot imagine any American liking their healthcare plan. No matter how expensive your plan is, the simplest interactions like changing a birth control prescription or getting new glasses are absolute torture.
- codingdave 3y ago
  UHC is great under one circumstance - if you and your family are all relatively healthy, so your coverage needs are just visits to the family doc or maybe an occasional injury. Many people fit that scenario, so may not realize that it can get bad once you start dealing with chronic problems, unusual cases, needing atypical prescriptions, etc. Basically, it is a product made for the 80%, and the 80% don't realize how badly screwed the 20% are.
place_order 3y ago
Most health issues are connected to food. Synthetic sugars, seed oils, herbicides, pesticides, and diminished quality of vitamin mineral content. If you think the heal5 care industry has it locked up look into ag.
NoPedantsThanks 3y ago
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lvl102 3y ago
Covered this space from an investment angle for nearly two decades. These guys are crooks. It’s a controversial take but UNH (and everything else in healthcare) became so big directly as a result of PPACA. That should really be Obama’s legacy. US healthcare system is broken because both the right and left are completely bought by these monsters.
- Geeek 3y ago
  Can you guide me where I can read up more on this?
TheAceOfHearts 3y ago
I started following this person called Doctor Glaucomflecken who makes funny short skits on TikTok and YouTube, and that was how I first learned about United Healthcare. The wild thing is that he makes these funny videos so you think it's a joke, but then you look it up and realize it's real. Healthcare in the US is not in a good place, so this definitely sounds like a good action.
- xyst 3y ago
  those short videos are based on propublica stories. The "30 days of healthcare" series was pumped by the algorithm to me as well
jaredhallen 3y ago
I've had United for a little over a decade, and overall I have to say it's been pretty good. My wife was hospitalized for about a month with our first born, racking up hospital bills over half a million USD. I think I paid about $3500 out of pocket. Then, a number of years later, the same child had her appendix removed. Again, terrifying bills, and about $3500 out of pocket. That being said, after the second event, we had discharge orders from the surgeon that included very specific conditions for when we should bring her in. When some of those conditions presented, we brought her to her (in network) primary care physician, whose office is (incidentally) in our in-network hospital. The physician agreed with our having brought her in, and recommended a CT scan. My daughter was sent down the hall from her in-network pediatrician to the in-network emergency room where the CT machine was located. CT scan proceeded, findings were good, and my daughter recovered just fine. So imagine my surprise when I get a bill for the CT scan. After many phone calls, emails, registered letters, etc. the final determination was that the ER was, at the time of the events in question, had been staffed by an out-of-network third party and thus would not be covered. Now in the scheme of things, the CT scan was a drop in the bucket compared to everything that was covered, and I'm very thankful for how things worked out. But the principal of that situation really left a bad taste in my mouth. We had no reason to suspect that the CT scan wouldn't be covered, and were in no way advised as such. Doesn't seem right.
- codegeek 3y ago
  "My wife was hospitalized for about a month with our first born, racking up hospital bills over half a million USD" The problem is here and it is not pretty good. A month of hospitalization should not cost half a million dollars anywhere in the world. Most of this is because of the multiple middle men involved including the biggest mafia: health insurance companies. I don't mean in an insulting way but this is the thinking that keeps us americans getting scrfewed by these mafia.
- nradov 3y ago
  Some of those abusive billing practices by out-of-network providers are now prohibited by the No Surprises Act. https://www.cms.gov/nosurprises https://www.cms.gov/nosurprises
- 3y ago
gazpacho 3y ago
I think the main problem is lack of free market. Oligopolies are part of the problem, but an equally large part is lack of choice from employes. Many (most?) insured in the US get their healthcare through their employer. You get maybe 2 choices of insurer, often only one. You’re not going to get a new job to switch insurers. The people negotiating the plans are too far away from the people receiving care (it’s probably the finance people anyway). Not everyone has the same healthcare needs or lives in the same area, group plans don’t make sense in today’s world. The government should be promoting and incentivizing ICHRAs and similar. If you haven’t heard of ICHRAs they allow employers to give you a stipend for healthcare. You get to choose your plan (including open marketplace plans, which have some affordability regulations), you can use it for copays or to just pay for stuff out of pocket. You can choose a catastrophic plan and get insurance / a plan from your PCP so you never have to worry about “network” changes. And it’s tax free for employers and employees. Cheaper for employers too, they don’t have to hire benefits administrators and negotiate with brokers/insurance companies. If you’re a company, especially a mid to small sized one, I highly encourage you to look into ICHRAs.
- ClumsyPilot 3y ago
  > lack of free market. Oligopolies are part of the problem Free market produces Oligopolies, monopolies, cartels and collusion. They are perfectly absolutely natural formations. FAANH Companies form anti-poaching agreements, now they suddenly all have layoffs at the same time, you think that’s a coincidence? Even drug cartels divide up territories instead of ‘competing’.
  - RamblingCTO 3y ago
    Yes, I think the better wording is: there's no efficient market/competition going on
    - gazpacho 3y ago
      Yes exactly. It’s a regulated market, but regulated by private companies.
  - 3y ago
SlightlyLeftPad 3y ago
I want to know who exactly the “industry officials who compete with the healthcare giant” they’re interviewing are. The price fixing and collusion go way way deeper and broader than just United Healthcare and Optum.
xyst 3y ago
end private health insurance. single payer system needed.
om154 3y ago
The healthcare system in the United States is so hard to navigate. I recently switched to Sedera (https://sedera.com/ https://sedera.com/). They to have much better incentives, better prices and service. We'll see how it goes
claytongulick 3y ago
I see a lot of comments on here about how to "fix" the system, ranging from informed to terribly uninformed. There's one thing that I haven't seen mentioned that would be a great place to start: Be healthy. I know, many people don't have that choice. There are hereditary conditions, and accidents and chronic conditions - I know. I work in the industry. However, as a nation we've largely chosen to outsource our health. It makes sense, in a world that operates around specialization, we tend to follow those patterns for everything. Electrical problem? Call electrician. Plumbing problem? Call plumber. Health problem? See a doctor. It's understandable, but it's reactive and not an optimal solution for wellness. Consider these leading areas of healthcare costs in the U.S.: Obesity: 173 billion per year. [1] Diabetes: 412 billion per year. [2] Heart disease & stroke: 216 billion per year. [1] Smoking: 240 billion per year. [3] And alcohol just makes all of that way worse. [4] Most of the above can be controlled. If we really want to reduce costs and improve healthcare, I think it's best to start at home and work towards making sure we and our families are healthy and fit. It's not easy, and it takes a lot of education and work, but it's worth the effort. If Americans did that, we could reduce healthcare spend and ease the burden of stressed medical systems. We'd all be healthier and happier. It's not the whole answer, but it would be a great start. The path we're on seems to be trending in the opposite direction. Processed foods, sedentary lifestyle, addictive additives, high stress jobs - it all adds up. I think rising healthcare costs are (amongst other things) a symptom of our choice to deprioritize our wellness. Sure there are lots of opportunities for disintermediation in the gordian knot of U.S. healthcare, and we should pursue good solutions. But we should start with what we can directly control: our diet and fitness. [1] https://www.cdc.gov/chronicdisease/about/costs/index.htm https://www.cdc.gov/chronicdisease/about/costs/index.htm [2] https://diabetes.org/newsroom/press-releases/new-american-diabetes-association-report-finds-annual-costs-diabetes-be https://diabetes.org/newsroom/press-releases/new-american-di... [3] https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/cost-and-expenditures.html https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast... [4] https://www.sciencedirect.com/science/article/pii/S2773065422000347 https://www.sciencedirect.com/science/article/pii/S277306542...
- ejb999 3y ago
  >>Be healthy. This - obviously a lot of things are out of our control, but it is also absolutely true that the vast, vast majority of health problems Americans have are all self-inflicted by decades of poor diet and lifestyle - as an individual, if you are concerned about the kind of care you are going to get when you need it, the very best and easiest thing you can do, is take as many actions as you can to avoid needing it. You can't control everything, but you can do your part to ensure a healthy life - if only for selfish reasons (i.e. that won't fix the healthcare problems in the country, but it will minimize your own need for it).
ejb999 3y ago
Just to provide a counter point to all the anti-UHC complaints here - some of which may be legit - my last job had UHC insurance, without question the absolutely best insurance I have ever had in my life - literally everything was covered, no denials, no referrals needed, very reasonable co-pays and honestly felt like I had a truly gold-plated health coverage. Now I switched to a new job, with a much small regional health insurance provided by new employer- and it sucks. Higher copays, more hoops to jump thru, penalized for going out of network (and that network is much smaller than UHCs) etc. I for one don't care how big UHC is, how many additional related businesses they own including pharmacies etc, especially if it allows them to control costs better up and down the delivery chain - if, as a consumer, that gives me excellent service and limits my out-of-pocket expenses, I see that as a good thing, so I am all for it.

525 points by moose_man 3y ago

Healthcare in the US is just another face of why the US is an economy and not a country.

Finally! Now do the Blues (please, please DOJ and FTC). And the major inpatient and provider oligopolies. Market concentration across many layers is a huge reason we spend 17% of US GDP on healthcare.

anotheruser13 3y ago
And all the private equity firms that created some of these monsters.

moose_man 3y ago

https://archive.ph/meOGZ https://archive.ph/meOGZ

stop50 3y ago

I sense a new glauckomflecken video.

LordDragonfang 3y ago
My first thought as well. Everything I know about UH and Optum (all of it negative) come from his videos, and it makes me appalled that any company like this is allowed to exist, when every study seems to indicate that patient in private-equity-owned care experience worse, more expensive care. It's the opposite of "capitalism creating efficiency".
- NickC25 3y ago
  >opposite of "capitalism creating efficiency" It's rent seeking behavior by an actor that pretty much is a negative value-add from a patient's perspective. They are a cancer.
- stop50 3y ago
  Its my primary source of Schadenfreude, because whenever he says anything about insurance covering, i usually research it and come up with that it is covered.
  - LordDragonfang 3y ago
    Covered according to what source? The ones the insurances provide? Because the single most frequent complaint I hear about insurance is them deciding that something which they claim to cover, and should cover, they're suddenly no longer going to pay for because of some bullshit excuse. It's one of the reasons doctors have to waste hours of their time every week getting "prior authorizations" for things the insurance claims they will cover.
    - stop50 3y ago
      They are legally Required to cover it. An council checks every new drug if it helps and if the price is appropiate. That is done for each drug indipendent of the regulation of the drug. the insurance has very few things to deny an claim(in most cases they deny them because an doctor abbreviated his/her title, but due an new method to transport the receipts its very probably that the number will drop) and none if the doctor deems it absolutly nessesary.
athenot 3y ago
For those not familiar, here is the one on Optum & United Healthcare: https://www.youtube.com/watch?v=_khH6pZnHCM https://www.youtube.com/watch?v=_khH6pZnHCM
- John23832 3y ago
  “Jimothy, when you make enough money, you get to write the laws.”

mindslight 3y ago

How is there an argument of wrongdoing here when the regulatory approach for healthcare is still based around this idea that multiple anticompetitive arrangements (the price fixing between providers and "insurers") will somehow actually create competition? Like don't providers have to be standing alone as their own market independent of payer before one could say that UHC's actions here are specifically anti-competitive, rather than just the HMO system working as envisioned?

throwway120385 3y ago

Given the way United Healthcare is organized, with Optum as a second party that all claims or other billing issues is directed to, this allows them to very effectively point the finger at each other whenever there is a dispute. Optum in turn owns a lot of care providers including a ton of providers in my area. They have used this as a cudgel in the past, as someone I know was slammed with a bill during Optum's takeover of one of their providers. The Optum employee wouldn't provide any information about the charge and simply fired them as a patient for not paying it. Because Optum is buying up clinics left and right where we live this person has lost access to their PCP on multiple occasions as Optum buys more and more healthcare groups. UHC and UnitedHealth group need to be broken up, and these incestuous relationships between insurance companies, private equity companies, and care providers need to be stopped by the SEC, because their only purpose is to exploit the wrapping up of care providers under one umbrella to extract more money for less work from people seeking essential services.

datavirtue 3y ago
Sounds like the pitch to investors.
kurthr 3y ago
They key point is that healthcare insurers, pharmacy benefit managers, pharmacies, and healthcare groups are all owned by one holding company which benefits when prices go up. People think that the insurer will try to keep costs down, but in fact, if prices go up they can charge more for insurance... the only way they can keep increasing shareholder value is for prices to go up. So they do, and by owning the entire chain they can force that to happen. There is no market. Insurers will not negotiate prices lower, it is against their interests!
- throwway120385 3y ago
  In Optum/UHC's specific case, I can give an example of this from using their IVF benefits. In one plan we had from them my partner was entitled to 10k for treatment and 15k for medications. Optum Specialty Pharmacy was the only in-network pharmacy for the IVF drugs. When we started ordering IVF medications under insurance, we found out that the price the pharmacy charged insurance was over 3x what their cash price was for nearly everything. We ran out of the 15k in a single retrieval cycle because of this, and wound up with a bill to the tune of several thousand dollars because one specific prescription ended up partially billing to insurance. People often lose sight of the fact that when you bill insurance, even if the item is only partially covered, the charge you must pay is the insurance negotiated rate even if the insurance is capped well below the price of the charge. We concluded that the medication benefit was a huge racket because of this, and I would imagine Optum rakes in thousands of dollars per patient on something that according to the policy documents is fully covered. Meanwhile other nationwide pharmacies like Alto Pharmacy do offer the drugs at very reasonable prices, often 1/5 to 1/10 what Optum was charging.

NickC25 3y ago

>UnitedHealth executives have said that Optum and UnitedHealthcare don’t favor one another Yeah, that's laugh-out-loud levels of bullshit. You think executives are just going to admit to facilitating what effectively is a form of racketeering? NINJA EDIT: The Optum arm itself needs to be broken up into a bunch of smaller pieces. United Healthcare also needs to be broken up.

Auracle 3y ago
That's insane. The archive link isn't working for me so I can't read the article, but we received a letter that any long term prescriptions might need to go through Optum and that we'd only be able to fill a few at a local pharmacy before the refused to cover them. I was a bit flabbergasted as that didn't seem like it could possibly be legal. By the way - that's absolutely not great if you have controlled medications, as you need to sign for them and can't exactly get them filled early. I take three different ones. Luckily my wife and I work from home.
- justinclift 3y ago
  > The archive link isn't working for me ... For me, that link bounces to the archive.md version of it (same url, but archive.md domain), which is resolving to 139.99.171.251. You can probably get it to work by adding an override in your /etc/hosts (or equivalent) file, and using the archive.md version of the url. In theory. ;)

bearjaws 3y ago

Go after all the healthcare giants. If people knew even half of how consolidated their treatment was, they would riot. For those who don't know about the significant conflict of interest present here: 1. United is a health insurer that has to make payments for people's 2. United owns several physician networks (totaling 90,000 physicians), who then determine what your care should be—no conflict with the fact that they pay the bills... 3. United owns Optum, which determines how much your drugs are going to cost, and of course, who makes them—brand vs. generic, etc. 4. Optum runs its own mail order and specialty pharmacies. Optum also writes your care plans for many chronic diseases and ships medications all over the country. 5. Optum could require their own customers to use their care plans and software in order to receive medications at all, or mark up the price for anyone who doesn't. Let's step through a workflow. You, a patient on United, go to a physician for treatment. Later on, you get referred to a specialist, then get diagnosed with a chronic disease and need medication that you receive delivered monthly. That pans out to: United pays United, who refers you to United, that forwards you to Optum (owned by United), who gets paid by United. Each and every month. Let's say you find a better deal for your medication at another pharmacy. Too bad, its not going to be in your network and Optum will no longer cover it. How is a health system or an independent supposed to compete with that level of integration? This, of course, does not result in any savings or quality of life improvement for the patient or the physician. United and Optum charge the same prices as everyone else, or more.

yborg 3y ago
You didn't even mention Optum Bank, which they use to also sponge up that sweet HSA cash lest any drop of healthcare spend somehow escape UHG's toll.
sensanaty 3y ago
Imagine if the useless governments actually broke up these behemoth megacorporations that control the entire vertical and horizontal slice of industry they operate in. What a crazy concept, right?
rapatel0 3y ago
> 2. United owns several physician networks (totaling 90,000 physicians), who then determine what your care should be—no conflict with the fact that they pay the bills... I disagree that this is necessarily a bad thing. One of the critical problems with our current model is the Fee-For-Service. When the insurance company is separate from the payer, then the incentive is to treat patients like revenue. A significant part of our ballooning costs are due to this fundamental miss-incentive. When the payer and provider are the same entity, that is the one of the only effective mechanisms to control costs. I've thought about this a lot and I think that there are 3 critical changes that would fix the whole fucking thing: - Insurance being one country scale pool of capital - Actually average out the risk across lifetime - Every provider must be the payor - Incentivize hospitals to manage costs - Individual vouchers to join a network - Give the patient agency to join a care network that manages their health well.

ChrisArchitect 3y ago

Related: US pharmacy outage triggered by 'Blackcat' ransomware at UnitedHealth unit, sources say https://www.reuters.com/technology/cybersecurity/cyber-security-outage-change-healthcare-continues-sixth-straight-day-2024-02-26/ https://www.reuters.com/technology/cybersecurity/cyber-secur... (https://news.ycombinator.com/item?id=39524514 https://news.ycombinator.com/item?id=39524514)

Blackthorn 3y ago

Optum is the most garbage organization that has absolutely ruined local healthcare. I go out of my way to find places that aren't affiliated, even though they're much further distance, just to avoid them. It's about time this happened.

dandigangi 3y ago

Do Discover/Capital One next.

codegeek 3y ago

All health insurance companies need to die. They are all crooks and frauds and are using an outdated system in our country siphoning money from families.

Spivak 3y ago
This opinion isn't actually all that drastic. If we just got people on the HSA + disaster coverage* train a lot of the issues with the system would disappear. I am far far from the cheapest patient but my annual spending doesn't even get to 50% of my portion of the premiums of my employer's PPO plan. * Where if a doc prescribes insurance pays for it no questions asked (to you the patient). They can claw it back from the doctor if they think it's excessive. I think for disaster only coverage you could successfully pass laws to this effect without insurance companies starting a third world war.
- wildrhythms 3y ago
  Why would your ideal solution still involve insurance? I think most people want the hospital (they don't care who runs it) to send the bill to the government. That's it. And if the state or federal government wants to set up a system of oversight over the charges, then good.
  - lotsofpulp 3y ago
    > And if the state or federal government wants to set up a system of oversight over the charges, then good. That is what happens now. See Medicare/Medicaid/Tricare/federal government employee plans/etc. That is why health insurance companies are better referred to as “managed care organizations” (MCOs). Most importantly, they are selling a plausible deniability shield to government leaders. The government is paying for healthcare, but since there is insufficient supply of healthcare, someone has to get shafted. Using the MCOs to do it lets government leaders point fingers.
SlightlyLeftPad 3y ago
A-f**ing-men

FireBeyond 3y ago

My "favorite" story about UHC is from a provider perspective. Taking a page from Section U in The Rainmaker ("deny all claims"), they went through a phase where multiple people took them to court over HEMS (helicopter EMS) transport denials, including from the scene of serious car accidents, due to lack of "pre-authorization". Apparently in their mind, us paramedics (or maybe the chopper pilot) should have been calling their 800 number as we stabilized our patient... "This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the hospital due to extensive multisystem trauma but we need a pre-auth. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, I know, I know, sorry, it's a bit loud with the jaws of life and the engines... What's that? Um, sure, yes, I can hold for a nurse consult..."

voakbasda 3y ago

UnitedHealth is by far the worst health coverage I have ever had. They are so bad at paying claims that our local hospital network has dropped them; all of our emergency care in the immediate region is now out-of-network. They absolutely are criminals and deserve to be put out of business.

earthwalker99 3y ago
A friend of mine couldn't get his claims paid even as a UHC corporate employee. He ended up quitting his job at a health insurance company because he wanted functional health insurance.

rainbowzootsuit 3y ago

Not shilling here, merely impressed by the work of journalist Marshall Allen—he has a book "Never Pay the First Bill". Search around on podcasts and YouTube for some interviews to get the jist. I've bought a few copies for friends that had expensive health issues and have used the techniques on relatively small stuff for myself.

camhart 3y ago

We signed up for a United Healthcare plan a couple years back. It showed a bunch of Doctors in network. Once we were on the plan, 90%+ of the Doctors told us they didn't accept United Healthcare or weren't accepting new patients. We couldn't find quality Doctors near us as a result. Ended up having to switch off United Healthcares plan as a result. Certainly felt like it was false advertising to say all the Dr's are in network just to find out none of them will treat you.

burkaman 3y ago
It is absolutely false advertising and probably illegal, and it's not just you: https://jacobin.com/2024/01/health-insurance-giants-companies-unitedhealthcare-directory-in-network-providers https://jacobin.com/2024/01/health-insurance-giants-companie.... There has been some congressional interest (https://www.finance.senate.gov/chairmans-news/wyden-calls-for-action-to-get-rid-of-ghost-networks-releases-secret-shopper-study https://www.finance.senate.gov/chairmans-news/wyden-calls-fo...) but I think it would take a big class action lawsuit or something to "fix" this. Obviously the only actual fix is universal coverage though.

Wh1skey 3y ago

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sabujp 3y ago

There's also this : https://www.reuters.com/technology/cybersecurity/cyber-security-outage-change-healthcare-continues-sixth-straight-day-2024-02-26/ https://www.reuters.com/technology/cybersecurity/cyber-secur... , this hack caused by malware from 2021, caused huge portions of their employee base tied to optum and their change healthcare acquisitions to be unable to work for days (and it's still ongoing!). I guess their employees got a "vacation" out of it while everyone else waiting on prescriptions at CVS, etc got shafted. It literally took a huge portion of the US pharmacy network to go down for the US to realize what a big problem UNH is.

bithead 3y ago
Former Optum/UHG employee, worked in automating things in IT. While I was there they went on a years long spree to get rid of everyone under 40. I finally got laid off and in my group of 153, 17 were under 40. I had automated most everything in my area,and although I meticulously documented everything, when you get the plug pulled like that you don't get time to do any hand off, so it hit things pretty hard. They did this for months (laying off people under 40). They gave me a large enough severance to cover a long time out of work, and the severance agreement stated if I sued for EIRSA I had to pay it back. I took it, but the entire thing painted a picture of management totally disconnected from the people putting code to programs.

roberttod 3y ago

All the awful reviews of united here, and yet it's reviewed as one of the highest rated insurance agencies (for example see https://www.forbes.com/advisor/health-insurance/best-health-insurance-companies/ https://www.forbes.com/advisor/health-insurance/best-health-...) Are these reviews completely paid for? What's going on here? Or are all the options awful. I am in the position to choose our provider at our (small) company, but between Gusto and JustWorks and the majority of our employees being in Texas there was slim to none options except united.

jjulius 3y ago
The criteria that your Forbes piece judges UHC on don't seem to be the things that people are complaining about. Seems that the Forbes piece is more of a surface-level judgement than anything.
SlightlyLeftPad 3y ago
Yes
burkaman 3y ago
All the options are awful. Obama got in trouble for saying "if you like your plan you can keep it" when promoting the Affordable Care Act, because it wasn't true, but in some sense it was true because I truly cannot imagine any American liking their healthcare plan. No matter how expensive your plan is, the simplest interactions like changing a birth control prescription or getting new glasses are absolute torture.
codingdave 3y ago
UHC is great under one circumstance - if you and your family are all relatively healthy, so your coverage needs are just visits to the family doc or maybe an occasional injury. Many people fit that scenario, so may not realize that it can get bad once you start dealing with chronic problems, unusual cases, needing atypical prescriptions, etc. Basically, it is a product made for the 80%, and the 80% don't realize how badly screwed the 20% are.

place_order 3y ago

Most health issues are connected to food. Synthetic sugars, seed oils, herbicides, pesticides, and diminished quality of vitamin mineral content. If you think the heal5 care industry has it locked up look into ag.

NoPedantsThanks 3y ago

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lvl102 3y ago

Covered this space from an investment angle for nearly two decades. These guys are crooks. It’s a controversial take but UNH (and everything else in healthcare) became so big directly as a result of PPACA. That should really be Obama’s legacy. US healthcare system is broken because both the right and left are completely bought by these monsters.

Geeek 3y ago
Can you guide me where I can read up more on this?

TheAceOfHearts 3y ago

I started following this person called Doctor Glaucomflecken who makes funny short skits on TikTok and YouTube, and that was how I first learned about United Healthcare. The wild thing is that he makes these funny videos so you think it's a joke, but then you look it up and realize it's real. Healthcare in the US is not in a good place, so this definitely sounds like a good action.

xyst 3y ago
those short videos are based on propublica stories. The "30 days of healthcare" series was pumped by the algorithm to me as well

jaredhallen 3y ago

I've had United for a little over a decade, and overall I have to say it's been pretty good. My wife was hospitalized for about a month with our first born, racking up hospital bills over half a million USD. I think I paid about $3500 out of pocket. Then, a number of years later, the same child had her appendix removed. Again, terrifying bills, and about $3500 out of pocket. That being said, after the second event, we had discharge orders from the surgeon that included very specific conditions for when we should bring her in. When some of those conditions presented, we brought her to her (in network) primary care physician, whose office is (incidentally) in our in-network hospital. The physician agreed with our having brought her in, and recommended a CT scan. My daughter was sent down the hall from her in-network pediatrician to the in-network emergency room where the CT machine was located. CT scan proceeded, findings were good, and my daughter recovered just fine. So imagine my surprise when I get a bill for the CT scan. After many phone calls, emails, registered letters, etc. the final determination was that the ER was, at the time of the events in question, had been staffed by an out-of-network third party and thus would not be covered. Now in the scheme of things, the CT scan was a drop in the bucket compared to everything that was covered, and I'm very thankful for how things worked out. But the principal of that situation really left a bad taste in my mouth. We had no reason to suspect that the CT scan wouldn't be covered, and were in no way advised as such. Doesn't seem right.

codegeek 3y ago
"My wife was hospitalized for about a month with our first born, racking up hospital bills over half a million USD" The problem is here and it is not pretty good. A month of hospitalization should not cost half a million dollars anywhere in the world. Most of this is because of the multiple middle men involved including the biggest mafia: health insurance companies. I don't mean in an insulting way but this is the thinking that keeps us americans getting scrfewed by these mafia.
nradov 3y ago
Some of those abusive billing practices by out-of-network providers are now prohibited by the No Surprises Act. https://www.cms.gov/nosurprises https://www.cms.gov/nosurprises
3y ago

gazpacho 3y ago

I think the main problem is lack of free market. Oligopolies are part of the problem, but an equally large part is lack of choice from employes. Many (most?) insured in the US get their healthcare through their employer. You get maybe 2 choices of insurer, often only one. You’re not going to get a new job to switch insurers. The people negotiating the plans are too far away from the people receiving care (it’s probably the finance people anyway). Not everyone has the same healthcare needs or lives in the same area, group plans don’t make sense in today’s world. The government should be promoting and incentivizing ICHRAs and similar. If you haven’t heard of ICHRAs they allow employers to give you a stipend for healthcare. You get to choose your plan (including open marketplace plans, which have some affordability regulations), you can use it for copays or to just pay for stuff out of pocket. You can choose a catastrophic plan and get insurance / a plan from your PCP so you never have to worry about “network” changes. And it’s tax free for employers and employees. Cheaper for employers too, they don’t have to hire benefits administrators and negotiate with brokers/insurance companies. If you’re a company, especially a mid to small sized one, I highly encourage you to look into ICHRAs.

ClumsyPilot 3y ago
> lack of free market. Oligopolies are part of the problem Free market produces Oligopolies, monopolies, cartels and collusion. They are perfectly absolutely natural formations. FAANH Companies form anti-poaching agreements, now they suddenly all have layoffs at the same time, you think that’s a coincidence? Even drug cartels divide up territories instead of ‘competing’.
- RamblingCTO 3y ago
  Yes, I think the better wording is: there's no efficient market/competition going on
  - gazpacho 3y ago
    Yes exactly. It’s a regulated market, but regulated by private companies.
- 3y ago

SlightlyLeftPad 3y ago

I want to know who exactly the “industry officials who compete with the healthcare giant” they’re interviewing are. The price fixing and collusion go way way deeper and broader than just United Healthcare and Optum.

xyst 3y ago

end private health insurance. single payer system needed.

om154 3y ago

The healthcare system in the United States is so hard to navigate. I recently switched to Sedera (https://sedera.com/ https://sedera.com/). They to have much better incentives, better prices and service. We'll see how it goes

claytongulick 3y ago

I see a lot of comments on here about how to "fix" the system, ranging from informed to terribly uninformed. There's one thing that I haven't seen mentioned that would be a great place to start: Be healthy. I know, many people don't have that choice. There are hereditary conditions, and accidents and chronic conditions - I know. I work in the industry. However, as a nation we've largely chosen to outsource our health. It makes sense, in a world that operates around specialization, we tend to follow those patterns for everything. Electrical problem? Call electrician. Plumbing problem? Call plumber. Health problem? See a doctor. It's understandable, but it's reactive and not an optimal solution for wellness. Consider these leading areas of healthcare costs in the U.S.: Obesity: 173 billion per year. [1] Diabetes: 412 billion per year. [2] Heart disease & stroke: 216 billion per year. [1] Smoking: 240 billion per year. [3] And alcohol just makes all of that way worse. [4] Most of the above can be controlled. If we really want to reduce costs and improve healthcare, I think it's best to start at home and work towards making sure we and our families are healthy and fit. It's not easy, and it takes a lot of education and work, but it's worth the effort. If Americans did that, we could reduce healthcare spend and ease the burden of stressed medical systems. We'd all be healthier and happier. It's not the whole answer, but it would be a great start. The path we're on seems to be trending in the opposite direction. Processed foods, sedentary lifestyle, addictive additives, high stress jobs - it all adds up. I think rising healthcare costs are (amongst other things) a symptom of our choice to deprioritize our wellness. Sure there are lots of opportunities for disintermediation in the gordian knot of U.S. healthcare, and we should pursue good solutions. But we should start with what we can directly control: our diet and fitness. [1] https://www.cdc.gov/chronicdisease/about/costs/index.htm https://www.cdc.gov/chronicdisease/about/costs/index.htm [2] https://diabetes.org/newsroom/press-releases/new-american-diabetes-association-report-finds-annual-costs-diabetes-be https://diabetes.org/newsroom/press-releases/new-american-di... [3] https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/cost-and-expenditures.html https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast... [4] https://www.sciencedirect.com/science/article/pii/S2773065422000347 https://www.sciencedirect.com/science/article/pii/S277306542...

ejb999 3y ago
>>Be healthy. This - obviously a lot of things are out of our control, but it is also absolutely true that the vast, vast majority of health problems Americans have are all self-inflicted by decades of poor diet and lifestyle - as an individual, if you are concerned about the kind of care you are going to get when you need it, the very best and easiest thing you can do, is take as many actions as you can to avoid needing it. You can't control everything, but you can do your part to ensure a healthy life - if only for selfish reasons (i.e. that won't fix the healthcare problems in the country, but it will minimize your own need for it).

ejb999 3y ago

Just to provide a counter point to all the anti-UHC complaints here - some of which may be legit - my last job had UHC insurance, without question the absolutely best insurance I have ever had in my life - literally everything was covered, no denials, no referrals needed, very reasonable co-pays and honestly felt like I had a truly gold-plated health coverage. Now I switched to a new job, with a much small regional health insurance provided by new employer- and it sucks. Higher copays, more hoops to jump thru, penalized for going out of network (and that network is much smaller than UHCs) etc. I for one don't care how big UHC is, how many additional related businesses they own including pharmacies etc, especially if it allows them to control costs better up and down the delivery chain - if, as a consumer, that gives me excellent service and limits my out-of-pocket expenses, I see that as a good thing, so I am all for it.