Nothing substantive to add except to say that Kaiser literally saved my life on numerous occasions when I was younger (and we didn’t go bankrupt due to it) snd I wish i had the option of having them as my health benefits now.
The United Healthcare parent company CEO has issued comment on the situation
Basically, it’s complicated, it’s unfortunate, and we need to do a better job of helping people understand what’s covered and why we deny what we deny.
Just to add:
I have a cadillac BCBS plan through my wife’s work. I’ve never had a problem, and never had more than a couple hundred dollars come out of pocket. I’m amazed at how little prescriptions cost us. But, while we both have our issues, we’ve never had cancer or major surgeries or other really big events. So I don’t know how that would play out.
I also know that the plan is something like $30,000 per year to her employer. So it’s pricey.
That is potentially very good news.
This. I think UHC tends to deliver lower premium prices to employers with that worse health coverage.
Ah well. I’m still going to hope.
It’s not the only problem, but it’s an increasingly large problem. I’m currently buying most of my meds outside of insurance coverage, because it’s cheaper to bypass Express Script than to “use” the “benefit”. Like, cheaper by a factor of 20 for one drug. Same size of the same brand of the same stuff, too. (I currently have the “insurance” provided and the “outside insurance” tubes side by side in my bathroom.)
Those with Cadillac plans need to scroll up to my old post and check their insurer. If you have Anthem and you think it’s the same as Blue Cross/Blue Shield, think again. Blue Cross is a franchise handed out to various regional insurance companies around the country. Anthem has high denial rates, the average BCBS has lower denial rates.
Thanks to the Affordable Care Act, you can compare denial rates across regional insurance companies. Everyone should do this. Open enrollment ends January 15, 2025. Kevin Drum has a chart with 162 insurers here.
Or go to the source and get the latest Transparency in Coverage Public Use File (PUF) here. You will need to work with Excel and enable editing to use the filters. Wow, that’s challenging. Well I trust HR has provided this information to their employees: that would be responsible in companies that perceive their workers as something other than cattle or line items.
Ok, the data as reported by the government is difficult to interpret. ProPublica:
Experts say they can’t tell if insurers with higher denial rates are counting differently or are genuinely more likely to leave customers without care or stuck with big bills.
“It’s not standardized, it’s not audited, it’s not really meaningful,” Peter Lee, the founding executive director of California’s state marketplace, said of the federal government’s information. Data, he added, “should be actionable. This is not by any means right now.”
Some years ago, my brother learned that insulin syringes were $10/box retail at CVS, but his insurer charged a $20 copay for all prescriptions.
Again, how we live in a place where that’s allowed is beyond me.
And what is additionally maddening is that CVS, who had to know this, never told him. He found out once when, in a pinch, he wasn’t able to cover them with a script (I think he left the box at home or some such, and wasn’t yet due for a refill) and he just asked “what do they cost if I don’t put them through insurance?”)
Looks like this only includes the plans under the national health plan, not ones operated by individuals states, such as Covered California (which is what I use).
CVS probably couldn’t tell him . Pharmacies are often gagged by their contract - and of course if his pharmacy benefit manager was CVS Caremark, CVS retail certainly wouldn’t tell him.
This article is from 2017 but I’m sure these clawbacks still happen - I know there were lawsuits but I never saw how they were resolved.
I have a BCBS plan (I’m retired from the federal government) and have had similar experiences to yours on non-surgery coverage. For surgeries, I’ve had to pay pretty substantial sums out of pocket, but the large majority of the cost was covered. Surgery is just damn expensive!
Covered California’s page on denied claims is here but it contains no ratios or analysis, just reports by the individual insurance companies. This article notes that Connecticut has annual reporting requirements: I’m guessing California does not, so the data may not reflect apples-to-apples comparisons.
The article also reports that consumers appeal 0.2% of claims despite their rights under the ACA to external review. They win 41% of the time, if I understand it correctly. NPR reports that in cases of bulk denials of claims, consumers win 90% of the time. Eventually. Deny, Delay, Defend.
Wait. UHC had a parent company, UHG? Oh, great.
Okay, Wiki says they also own Optum, which is a long-term care (mostly nursing and group homes) provider. My BFF worked for them for a while, and while he really liked the job, he had a really terrible boss. (Interestingly, on Monday he just started a new job at Walmart, aged 61.)
Hey, it’s C(onjugal)V(isits with)S(atan). Most likely, they were a loss leader, and they may also have had other problems (they leaked, had dull needles, etc.)
Anyway, back in my retail pharmacy days at least, if a prescription cost less than the copay, that was what they paid. In other words, if the copay was $10 and the prescription cost $6.73, the patient paid $6.73.
Optum is much more than that. They have three divisions that stretch across the landscape of the healthcare business inclusive of pharmacy benefits management, complex care management, revenue cycle management, analytics, and on. They have also purchased many physician groups, to the point that they are the nation’s largest employer of physicians:
Wow.
There was a story on the cable news today (no cite yet) about Trump’s plans to make sure that every single industry-consolidation proposal put forward is supported.
Why not just hang every consumer up by the ankles and torture us? It might be more efficient…
When the health insurance industry has enough cash to start buying the health CARE industry, something’s fucky with the insurance.
Permit me to pose a question. Say the accused doesn’t plea out and is found guilty by jury. Now it goes to sentencing. What are the aggravating factors that the judge is likely to identify? What are the mitigating factors that the judge is likely to identify?
What are the aggravating factors and mitigating factors that the judge will not allow? Should the judge allow those? What aggravating and mitigating factors should responsible citizens and armchair philosophers bear in mind outside of the courtroom?
This is one way of thinking about how bad this crime was. Murder is wrong; murder is bad; killing people is bad (though sometimes necessary). But how bad is this instance? Pretty bad I say, but I’d like to reflect upon the mitigating and aggravating factors.
Attacks on this framework and the question I posed are permitted, even encouraged.
ETA: The first paragraph and part of the 2nd depends on NY state law. The newly bolded part above does not. Also, if someone wants to discuss this in context of their local jurisdiction, have at it, since I’m mostly trying to sort through the moral philosophy.
Depends entirely on New York state law. I’ve got no idea.
Remember, kids - murder is always wrong and you should never stan a murderer no matter how dangerous or amoral their victim was, unless their victim was a homeless person in need of psychiatric help, in which case they will be invited to hang out with the president at a football game.
Disinhibition by the leaders of Leopards-Eating-Peoples-Faces Party has unintended consequence on CEO of ravenous corporation.
If the killer had actually been insured by UHC and gotten screwed- then maybe. But he wasnt.
“I dont like that unpopular industry so I will murder a CEO” doesnt work.
Well we are far into the era of physician practices being own by entities that include other interests. Heck even Amazon is trying to play in the space. Kaiser is insurer, hospitals, providers … they hire out for pharmacy benefits management (PBM) but not much else. CVS own Aetna, of course owns PBM, and physician groups, in particular Oak Street Health, a significant primary care network focused on Medicare Advantage. Walgreens is in the space buying primary care networks. Humana owns practices and is a co-investor in more. They’re all integrated across the space to some degree.
UHC has just gone wider and deeper than most.