UnitedHealth hired a defamation law firm to go after social media posts criticiz

In this case though, the claim should have been denied because it was filed incorrectly.

Is there also a reason the surgeon themselves needs to get on the phone with insurance? Isn't that what the rest of the staff is for?

It also matters whether they are actually reachable at your convenience. A lot of business are virtually impossible to actually talk to unless you answer their call. They say to call back at your convenience, but you will only get their voicemail or an infinite waiting queue.

Why? They presumably have recordings so it's unlikely to going to devolve to a "he said she said" situation, and I'm not sure how else you would rephrase "at your convenience" so the doctor wouldn't scrub out. Does every interaction need a 1 paragraph disclaimer to guard against a social media shitstorm?

The call center employee said 'at your convivence' knowing full well that they'd never be available at a convenient time.

It was 2024, it should not hinge on that at all. We have asynchronous communications, a timestamped email should be all the proof required.

If UNH requires others to communicate with them via complicated phone trees that waste callers' time, then that means UNH is automatically at fault.

> Medical providers aren't supposed to deny procedures based on insurance coverage.

This is false. There's EMTALA, which requires that emergency services will be provided until a patient can be transferred. But doctors absolutely refuse to provide services based on ability to pay all the time.

> Medical providers aren't supposed to deny procedures based on insurance coverage.

Only in a very specific, narrow set of circumstances.

https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...

It only applies to emergency assessment and stabilizing care, and only if the facility accepts Medicare patients.

>As far as I'm concerned, I still appreciate the propaganda value of a story even if it's full of half-truths like this one, because it's time for a reckoning for these companies.

Just like "2 weeks to flatten the curve" and "masks don't work"? There's no way that "the ends justifies the means, a little lie to advance our cause" would backfire, right?

Your response feels unnecessarily unkind

Well as mitchelist points out we don’t even know what claims were made. The third paragraph of this article reads

> On Jan. 7, a plastic surgeon named Elisabeth Potter posted a video of herself on Instagram claiming that UnitedHealthcare called her mid-surgery and asked her to justify an in-patient stay for a woman who has breast cancer and needed a surgical procedure to treat it. Potter then claimed that the insurer denied the patient an overnight stay and threatened her with legal action for her posts.

Are these claims? What does “surgical procedure” mean? In what way is she using the word “denied”? It says UHC threatened her with legal action for her posts but, as mitchelist has surmised, we don’t know what she said or if she said anything at all.

While the article articulates exactly what the surgeon said about UHC and links directly to her video of her saying it [1]… does it? Who knows what’s going on? I’d write more here but I am using speech to text because my dominant hand is stuck inside a jar of honey and my wife’s cries of “stop making a fist” (whatever that means) are getting picked up by my microphone.

1 https://www.instagram.com/p/DEid-1npNbA/?hl=en

> Health insurance in America is broadly profitable

Health insurance is actually a lot less profitable than most big businesses. Something like half as profitable as the S&P 500 average.

But ignoring that, there are also big non-profit insurers. They aren't appreciably different.

There's a big misconception that if we could just remove profit from our healthcare system every problem would be solved. However, if you look at where healthcare dollars go, profit and administrative overhead (insurance, hospital admin, etc.) are a single digit percentage of overall spending. If you could wave your magic wand and make it go away tomorrow, things would barely change.

Note that even countries with socialized medicine have administrative overhead in the single digit percentage range, so it's not actually possible to drive it to zero.

We severely overestimate how much of our healthcare dollars go to profits and executive compensation. I think because those are the only safe targets to be mad at. Nobody wants to engage in conversations about getting surgeons to take lower compensation or limiting certain types of care (which is very much a thing in any medicine system). American healthcare is expensive, but we Americans also consume (and demand) much more healthcare than elsewhere in the world.

All of the job of for-profit health insurance companies is to make money for their investors. Everything else they do works towards that goal.

Now all of the job of any for-profit company is to make money for their investors, that in and of itself is not a problem. The problem is that specifically, for health insurance companies, they make money by denying people health care. They have no incentive to pay claims beyond the minimum necessary.

We have public health care too and it isn't perfect but they don't lie to our faces when telling us why they won't cover something.

> Part of the job of a health insurer is to deny unnecessary claims, to be a check on providers, both in procedures and their pricing.

How can this occur with the given incentives? You have parent corp UHG who owns the whole vertical and you've got dumb fucking congress (deduced from Hanlon's razor) saying only a single part of that vertical is capped.

so glad the company that pays for my treatments can be "a check on providers" for me… /s

That was my guess, too.

The surgeon went to social media blaming UHC for everything, with the assumption that her own staff couldn't have been part of the miscommunication or paperwork errors.

UHC comes back, with receipts, showing that the error is somewhere on the hospital side.

That's certainly plausible... however, UHC is not saying "the doctor got it wrong, it was her receptionist's fault". They are sending legal threats - "take this speech down or we'll sue you for defamation". This is not a company trying to take their name out of the mud, this is a company trying to cut off their critics' tongues, because the critique is hurting the stock price.

> I've never seen people more devoted to making sure things don't get done.

This is the truth. People do not understand the depths of hell you are in when you are dealing with hospital admins.

It's not a bluff, it's basic practice to record calls when the interactions are high stakes. This was just a social media fight, but when the issue is malpractice or someone has died you can guarantee the lawyers will want recordings of those calls.

In states where recording requires consent you will get a pre-recorded message at the beginning of the call warning you that it's being recorded.

This i think depends on where you are with Kaiser; i know folks in Washington have bad times with them.

Kaiser doctors, because they're employees of the same organization that provides the insurance, are much less likely to prescribe treatments that will be denied. Which I like, don't get me wrong, but it's a double-edged sword. Many people with complex or hard-to-treat conditions feel that Kaiser isn't an option for them, because when they need some rare treatment another insurance company might fight you over, Kaiser simply won't prescribe it at all.

I don't see how those facts meaningfully changes the conclusion when the margin for the entire group, which includes the subsidiaries you mentioned was 3.6% last year and 6.1% the year before.

https://www.unitedhealthgroup.com/content/dam/UHG/PDF/invest...

> Those are "expenses" for that margin calculation

Source? They would be expenses for the insurance sub but profits for the consolidated public company. The latter are 22% (gross) and 4% (net).

I don’t have a horse in this race. But it seems like the problem is at the level of PBMs and providers more than insurers.

A large fraction of UHG profits come from their Optum subsidiary selling software to other payer and provider organizations. This is separate from the health insurance business. If broken out separately they would be one of the 20 largest US tech companies.

Is there any legal way to remove the leeches from the system?

Obviously murdering healthcare CEOs and shareholders isn’t legal, and I wouldn’t endorse that method.

Are there alternatives?

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The 80/20 rule[0] requires insurance companies to pay out at least 80% of premiums. That's revenue, not profit, and is independent of their costs.

So if they were a charity which magically had 0 costs the most payouts could increase is 20%.

Healthcare demand is infinite and providers have every incentive to inflate costs and recommend as many services as possible. I don't like our healthcare system but as it is, insurance companies play a necessary role of rationing care and there is no magical fix to claim denials.

[0] https://www.healthcare.gov/health-care-law-protections/rate-...

Profit goes to shareholders, not the board. The board is generally supposed to want more money to shareholders, not internal management. The incentives here are not great though, as being a board member is generally a cushy role for which one does not want to rock the boat.

However senior management generally wants to pump the stock price to get comp, not juice their salary. And to pump the stock price, they want money going to shareholders (or growth).

If they deny fewer claims then medical expenses will rise for their self funded employer customers, and then those customers will switch their health plans to a competitor like Cigna or Aetna. Most coverage rules are driven by large employers. UHC would be happy to offer a health plan which paid every single claim if that's what employers wanted: it would actually mean higher profits for UHC.

I do not like our healthcare system and would enthusiastically support reform. But your arguments really don't make sense.

The UHC CEO made 10M, even if we 10x that to 100M then if the CEO decided to give it all back, UHC could payout << 1% more claims.

Most commercial health insurers no longer bear much financial risk. Instead they primarily administer health plans on behalf of large self-funded employers. Actual insurance is mostly limited to individual and small group plans, which are a much smaller line of business.