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UnitedHealth Is Sick of Everyone Complaining About Its Claim Denials
- frenchtoast8 2y agoSuing (or threatening to sue) everyone and anything that speaks poorly about the company is an interesting PR response, isn't it? I'm used to companies just ignoring the issue and hoping it goes away.
- SpicyLemonZest 2y agoIt's an extremely common response. I think you're used to remembering stories as "companies just ignore the issue and hope it goes away", summarizing away all the day-by-day coverage of letters they sent telling people to stop being mean, and that's probably how most people will remember this story in a few years too.
- andrewfromx 2y agoThey are just the biggest. Cigna does the same type of denials but is way smaller.
- tills13 2y agoThey had the highest denial rate at 31% though.
- charliebwrites 2y agoMany companies can be incredibly bad while still having one of them be the worst It’s not an either or
- andrewfromx 2y ago[flagged]
- nine_zeros 2y agoThere is an easy fix - just don't issue so many denials. Or refund people's premiums. Things become very easy when you are willing to sacrifice exec pay and investor returns - at least temporarily.
- IncreasePosts 2y agoWhat percent of denials do you think would not happen, if everyone worked for the company for free?
- nine_zeros 2y ago>What percent of denials do you think would not happen, if everyone worked for the company for free? Wrong question. The correct question is - what percentage of denials would not happen, if exec pay and market cap is allowed to be cut by 75% while keeping the revenue the same.
- BoxFour 2y agoBased on some quick napkin math from their 10-K for FY 2023, they could afford to spend about 7% more in claims (107% of their current payouts, that is). If you cut exec comp to $0 and profits to $0, it's more like 9.7%.
- nine_zeros 2y agoNice math. 9.7% more claims makes it a substantially worthwhile endeavor.
- BoxFour 2y agoI’d be remiss if I didn’t also mention that 98% of that 9.7% (so 9.5 of the 9.7) comes from slashing profits to $0. Exec comp alone is just a rounding error by comparison.
- IncreasePosts 2y ago
- kelnos 2y agoPrivate insurance in the US needs to be completely dismantled, and we need to go to a single payer system. Not a panacea, of course, but what we have is so broken and irredeemable, it's the worst of all worlds. The US has best-in-class (if crazy expensive) health care despite our insurance system, not because of it.
- krupan 2y agoOur "insurance" sucks because of all the government involvement. Putting government completely in control would solve some problems, but I personally would like to see how things go if we do the opposite and take government out of it completely.
- curious_curios 2y agoI get the sentiment, but I can say without any hyperbole that would be a death sentence on the majority of people with chronic conditions.
- krupan 2y agoWhen people say things like this I feel sad that we seem to have no idea what insurance really is, or that people are free to organize help for others and that many many good people would freely choose to do so.
- sympil 2y ago… are free to organize help for others.. We have done so in the form of government. The whole promote the general welfare bit. The free rider problem is not an issue with publicly funded healthcare.
- krupan 2y agoGovernment forcing us all to do something a certain way is not people freely organizing. Sorry to break it to you. Please see my other comment in this thread for more of my thoughts on that.
- inamberclad 2y agoSeeing my health insurance deny hospital claims that were pre-authorized has been insane. The hospital checked in advance with my insurance that several operations would be covered and the insurance approved. Now that the bill comes, the insurance company has repeatedly denied and denied their claims. Health insurance companies are horrible and parasitic to everyone involved.
- breadwinner 2y agoDo us a service and please name your health insurance.
- culi 2y agoStatistically speaking, it's probably United Healthcare. The largest insurer and also has the highest denial rate
- FireBeyond 2y agoThat makes zero sense. Largest number of denials? Certainly. Largest denial rate is not implied by being the largest insurer. Yet by their denial rates, 30% above the industry average, you can reach one of two conclusions: 1. Every other insurer is acting as a charity and under denying claims it should, or… 2. UHC is issuing excessive denials.
- bentt 2y agoYep, no reason to protect the insurer here.
- solumos 2y agoThe big problem with health insurance is that it accounts for 17% of the US GDP, so although it's parasitic for everyone involved, it's basically indispensable to the economy. That's a big reason why the Affordable Care Act panned out the way it did, as a partnership with the insurance companies.
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- fader 2y agoIt's not just denials. This is anecdotal but my company moved from Aetna to UHC starting in January, and there are already dozens of threads in our internal slack about drug co-pays jumping 10-100x, despite the UHC rep's assurances that the plans were equivalent with what we had before.
- superkuh 2y agoMaybe there should be a government mediated system for "DMCA", denied medical claim arguements, where anyone could send in a DMCA against a health insurance company and automatically involve the formal legal court system at no cost to themselves. Normally I would not want to involve government but in situations relating to life and death I think it is justified (like other things govs regulate involving life/death).
- jimbob45 2y agoYeah, you’ve come to mostly the same conclusion as Mark Cuban(whole thread [0]). He agrees that you need some sort of watchdog to prevent fraud/waste/mistake but that insurance companies don’t work because their for-profit nature perverts their incentives. I don’t know if a government-based watchdog is the solution but I think you’re on the right track. [0] https://x.com/mcuban/status/1666973561108725760 https://x.com/mcuban/status/1666973561108725760
- tekno45 2y agoIf stuff like voluntary plastic surgery wasn't covered, what the hell kind of medical fraud would there be? We have OTHER systems to find doctors prescribing drugs, so wtf does insurance provide the consumer except a pathway to debt?
- gruez 2y ago>If stuff like voluntary plastic surgery wasn't covered, what the hell kind of medical fraud would there be? Off the top of my head: going to a doctor, conspiring with him to make an insurance claim that you had some sort of procedure done even though none was actually done, and splitting the claim check? Not saying this happens, but it's not hard to think of frauds you could perform even if "voluntary plastic surgery wasn't covered".
- fernmyth 2y agoThere's no reason for the doctor to involve any patients, other than to write their names down. These are fraud factories submitting thousands of templated claims per year.
- gruez 2y ago>There's no reason for the doctor to involve any patients, other than to write their names down. ...until the patient looks at his health insurance account and notices a charge that he doesn't recognize, or the insurance company decides to do a random audit of a claim.
- SpicyLemonZest 2y agoRight, it's true that insurance companies investigating and denying claims is a major constraint on claims fraud. That's why Medicare and Medicaid still deny a lot of claims (although not so many as UHC) despite being publicly run.
- Enginerrrd 2y agoOr there's things like doctors ordering dozens of tests to identify a particular cold virus even though it wouldn't change the treatment or patient outcome, and oh, it just so happens the doctor owns the lab. (A real example) Or a doctor prescribing a monthly massage to a patient. Or approving a questionable disability claim. etc. etc. Fraud finds a way to happen.
- fungiblecog 2y agoThis is what you get when profit is prioritised over every other factor. i'm not sure why anyone finds this surprising. Social democrats recognise the role of government is to put in place regulations that temper this kind of behaviour. under Trumps 'slash and burn' approach to regulation expect things to get worse on every field
- gosub100 2y agoInsurance didn't deny coverage under Obama or Biden's rule?
- novemp 2y agoDid you just see the word Trump and shut your brain off? Read the rest of their sentence: "expect things to get worse on every field"
- lostdog 2y agoGee, I wonder if there's a law famously referred to by Obama's name, that improved the appeals process for denials? Maybe the internet even has information on this that you could search for? [0] Yes, obviously Obama tried to improve this, and Trump at most ignored it, and will probably make it worse within the next few weeks. [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC3366385/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3366385/
- sheldoni 2y agoOne of the most interesting things about this whole situation is that nobody is trying to even pretend that the current system is fair or effective. The tone in media and from corporate PR, business leaders, and politicians is either silence or some version of "hey stop talking about that / well it's not MY fault." Everyone knows the system is unfair, parasitic, and literally murderous, but no one in power is willing to take responsibility of any kind or show real leadership in bringing change.
- lostdog 2y agoDemocrats improved it and got punished in elections. Republicans did nothing and got rewarded. You get what you incentivize.
- sebazzz 2y agoIs it the system that is the problem or the medical specialists who gamed the system to give as much income as possible?
- sershe 2y agoNah nobody knows that, it is a lie. The reason healthcare in the US is expensive is primarily providers. As reported by e.g. Vox. In fact us out of pocket spending is low compared to OECD, and overhead while relatively high is not huge. It's that the doctors and hospitals in the US are paid much more.
- burnte 2y agoAs someone who works in healthcare IT, I can ensure you that everyone is sick of United Healthcare, too. Such a PITA to deal with.
- ipython 2y agoThis is what’s frustrating with the current political situation. Since we are already wielding the sledgehammer, why not take it to this system, which would actually solve some real problems for every day people?
- weare138 2y agoI mean we're going to keep doing it but we're tired of hearing about it.
- loganc2342 2y ago> The company, meanwhile, has argued that “Dr. Potter’s claims that she was called out of surgery are false.” Were they there?
- relaxing 2y agoIt’s disappointing we don’t get any further investigation into this he said/she said argument. The cynic in me is inclined to believe the company is denying it to the press without regard to the truth, because they can. No one will hold them accountable, so there’s only upside to lying publicly. (We’re currently seeing this strategy play out in national politics as well.)
- hingusdingus 2y agoTempted to complain twice as hard now that I know it gets to them.
- deleted 2y ago[deleted]
- AdeptusAquinas 2y agoIt recently occurred to me that the crazy expense of the US Healthcare system (most expensive in the world, while also being terrible quality) might be by design: it keeps you desperately tied to your jobs. Just another threat enforcing that weird modern serfdom the Americans are so fond of, along with their unsolved homelessness and massive prison industry.
- antisthenes 2y agoWouldn't it be nice if we could just keep collecting premiums and get paid salaries for doing nothing productive for society? Honestly, it's like that Bilbo meme where he's thinking about keeping the Ring. I'm sure every neoliberal capitalist dreams of just entrenching themselves in some kind of regulatory-protected business model paradise, so that they can keep "running the business" for hundreds of years, but that's not a good thing to aspire to if you have even a shred of human decency or ethics.
- jimt1234 2y agoIt's bad when shareholders are begging the company not to be so evil.
- mitchbob 2y agohttps://archive.ph/2025.02.09-161325/https://www.rollingstone.com/culture/culture-news/unitedhealth-defends-image-claim-denials-mangione-thompson-1235259054/ https://archive.ph/2025.02.09-161325/https://www.rollingston...
- gcapu 2y agoI had a baby. Months later, UH retroactively denied all birth and baby care claims. They claimed I had other insurance, which I don’t. Now I get to prove a negative. So fun.
- istjohn 2y agoIt's clear that health insurance companies are awful, but I wish people weren't so quick to let medical providers off the hook. It takes two to tango, and health insurance companies have found medical providers are eager to protect the status quo. Under our system, companies are highly incentivized to spend lavishly on employee health insurance plans since those dollars are not counted as taxable income on the employee's tax returns. By law, at least 80% of those tax advantaged insurance premiums must be passed on to medical providers [0]. Healthcare providers further benefit from having insurance companies act as a cut-out between consumers and them. Consumers have minimal price sensitivity since their care has already been paid for by their employer in the form of health insurance premiums. Under single-payer, providers would be unable to play insurance companies off one another in price negotiations. So it's little wonder that the American Medical Association has been opposed to government-backed health initiatives throughout the 20th century [1]. Both the AMA and the American Hospital Association have joined with the pharmaceutical and health insurance industry to oppose Medicare for All [2,3,4]. Doctors have also lobbied to limit competition that could drive down their compensation. They have lobbied for caps on the numbers of doctors trained in the US and on Medicare reimbursements for resident physicians. A testament to the success of these limits is that in 2022, a quarter of US physicians were trained abroad [5]. The AMA has opposed expanding the scope of practice for nurse practitioners [6]. Resident physicians are subjected to grueling long hours in what amounts to an institutionalized hazing ritual, with residents working up to 28-hour-long shifts and 80-hour weeks under applicable duty hour regulations. Even these generous limits are routinely evaded by false reporting [7]. The Association of American Medical Colleges projects a shortage of up to 86,000 physicians by 2036 [8]. Meanwhile, despite most hospitals being nonprofit institutions and enjoying the concomitant tax benefits, they increasingly behave like rapacious capitalists. The Guardian reports [9]: > Since the 1990s, hospital systems across the US – for and not-for-profit alike – have relentlessly chased after market power, executing nearly 2,000 mergers with little pushback from overwhelmed federal antitrust regulators and indifferent state authorities. Research from the American Medical Association found that by 2013, 97% of healthcare markets in the US had little competition and were highly consolidated under Department of Justice antitrust guidelines. By 2021, that figure had risen to 99%. A 2023 Health Affairs study reported "substantial growth in nonprofit hospital operating profits and cash reserves" between 2012 and 2019 "but no corresponding increase in charity care" [10]. Direct-to-consumer advertising for health services ballooned from $542 million to $2.9 billion between 1997 and 2016 [11]. Stories have emerged of hospital staff steering patients toward unnecessary procedures and testing [9]; of exhorbitant charges, like $629 to put a bandaid on a finger [12]; and of fraudulent billing practices like upcoding [9]. ProPublica describes the case of Dr. Thomas C. Weiner, an oncologist at a Montana nonprofit hospital who was found to be routinely giving his patients unnecessary treatments. In one case, a patient died after 11 years of cancer therapy from treatment complications despite a biopsy in his medical record showing he never had cancer. An autopsy has confirmed the biopsy [13]. Over those 11 years, Dr. Weiner was paid over $20.1 million, billing up to 70 patient contacts a day [14]. Just last week, my wife had an otolaryngologist push to perform a closed reduction to straighten her broken nose despite a CT scan in her record showing that the fracture was not displaced. This was the third medical appointment she completed (ER, primary care, specialist) for an injury for which the ultimate treatment was OTC pain medication and ice. Insurance executives make easy targets, and they earn their bad rap, but it would be a mistake to ignore the other players in the medical industry. Everyone is at the feast, and we're on the menu. 0. https://www.healthcare.gov/glossary/medical-loss-ratio-mlr/ https://www.healthcare.gov/glossary/medical-loss-ratio-mlr/ 1. https://en.wikipedia.org/wiki/American_Medical_Association#Opposition_to_expanded_health_care_access https://en.wikipedia.org/wiki/American_Medical_Association#O... 2. https://www.nytimes.com/2019/02/23/us/politics/medicare-for-all-lobbyists.html https://www.nytimes.com/2019/02/23/us/politics/medicare-for-... 3. https://thehill.com/policy/healthcare/482797-american-medical-association-president-warns-of-one-size-fits-all-single/ https://thehill.com/policy/healthcare/482797-american-medica... 4. The New Yorker: Inside the AMA's Fight over Single-Payer Health Care - https://archive.is/u96Rn https://archive.is/u96Rn 5. https://en.wikipedia.org/wiki/American_Medical_Association#Restrictions_on_physician_supply https://en.wikipedia.org/wiki/American_Medical_Association#R... 6. https://www.ama-assn.org/practice-management/scope-practice/ama-successfully-fights-scope-practice-expansions-threaten https://www.ama-assn.org/practice-management/scope-practice/... 7. https://pmc.ncbi.nlm.nih.gov/articles/PMC3886449/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3886449/ 8. https://www.aamc.org/news/press-releases/new-aamc-report-shows-continuing-projected-physician-shortage https://www.aamc.org/news/press-releases/new-aamc-report-sho... 9. https://www.theguardian.com/us-news/2024/oct/17/indiana-medical-debt-parkview-hospital https://www.theguardian.com/us-news/2024/oct/17/indiana-medi... 10. https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.01542 https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.01542 11. https://jamanetwork.com/journals/jama/fullarticle/2720029 https://jamanetwork.com/journals/jama/fullarticle/2720029 12. https://www.vox.com/2016/5/13/11606760/emergency-facility-fees-american-health-care https://www.vox.com/2016/5/13/11606760/emergency-facility-fe... 13. https://www.propublica.org/article/anthony-olson-thomas-weiner-montana-st-peters-hospital-leukemia#:~:text=Weiner%20had%20diagnosed%20Warwick%20with,that%20he%20never%20had%20cancer. https://www.propublica.org/article/anthony-olson-thomas-wein... 14. https://www.propublica.org/article/thomas-weiner-montana-st-peters-hospital-oncology https://www.propublica.org/article/thomas-weiner-montana-st-...
- underseacables 2y agoAnd they wonder why so many people are supporting Luigi. I could never condone murder, but I understand and deeply sympathetic. United is the comcast of health insurance
- emocin 2y ago“Too fuckin bad”