Insurance companies are evil as Hell

[TexasTiger 14,071]

I know most folks need a job, but you have to give up a piece of your soul to countenance this evil.

https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis
On the 2021 phone call, which was recorded by the company, nurse Victoria Kavanaugh told her colleague that a doctor contracted by United to review the case had concluded that McNaughton’s treatment was “not medically necessary.” Her colleague, Dave Opperman, reacted to the news with a long laugh.

“I knew that was coming,” said Opperman, who heads up a United subsidiary that brokered the health insurance contract between United and Penn State. “I did too,” Kavanaugh replied.

UnitedHealthcare Employees Discuss the Denial of Christopher McNaughton’s Claim

David Opperman is an insurance broker who works for UnitedHealthcare. Victoria Kavanaugh is a nurse for United. In this recorded phone call from 2021, the two express relief that a doctor has turned down Penn State student Christopher McNaughton’s claim as “not medically necessary.”

 

Opperman then complained about McNaughton’s mother, whom he referred to as “this woman,” for “screaming and yelling” and “throwing tantrums” during calls with United. 

The pair agreed that any appeal of the United doctor’s denial of the treatment would be a waste of the family’s time and money. 

“We’re still gonna say no,” Opperman said.

More than 200 million Americans are covered by private health insurance. But data from state and federal regulators shows that insurers reject about 1 in 7 claims for treatment. Many people, faced with fighting insurance companies, simply give up: One study found that Americans file formal appeals on only 0.1% of claims denied by insurers under the Affordable Care Act.

Insurers have wide discretion in crafting what is covered by their policies, beyond some basic services mandated by federal and state law. They often deny claims for services that they deem not “medically necessary.”

When United refused to pay for McNaughton's treatment for that reason, his family did something unusual. They fought back with a lawsuit, which uncovered a trove of materials, including internal emails and tape-recorded exchanges among company employees. Those records offer an extraordinary behind-the-scenes look at how one of America's leading health care insurers relentlessly fought to reduce spending on care, even as its profits rose to record levels.

As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan.

[jj3jordan 2,160]

You'll get no argument from me.

[wdefromtx 3,494]

Yeah, I hate insurance companies. 

[SaltyTiger 8,526]

Learned from Hurricane Michael that insurance companies are in the business of damage control. The intent is to wear people down imho. I hired a public adjuster and had the luxury of time in fighting the insurer. Given the situation again I would hand all over to an experienced attorney day 1.

In medical situations and most damage situations people do not have time as an ally. The insured is most often already under stress. Makes life tough. Correct on “piece of your soul”.

[SLAG-91 1,604]

My sister and I went round and round with CNA regarding my late mother's long-term care insurance and their constant goal-post moving regarding qualifying for payouts...you're absolutely right about the stress that puts on you. It legit sent my blood pressure through the roof trying to talk to those soulless ghouls. 

Have had better interactions with non-medical insurance claims, to be fair, but CNA can KMA.

[johnnyAU 3,739]

I have no sympathy for insurance companies whatsoever

[Cardin Drake 2,074]

Insurance companies are soulless slime for sure.   I think single payer is inevitable, but you will trade in soulless slime corporations for soulless slime bureaucrats. 

[cbo 8,556]

Scum of the earth. Their mission is to look for any reason to deny coverage. 

People die, but profits soar!

By the way, they take the same approach to payment of providers' claims for services already rendered. It's routine business for hospital companies to sue insurance companies to get them to pay what they owe. 

Edited July 24 by cbo

[AUFAN78 4,130]

Long story, but I took on UnitedHealth and won. Probably helped that my neighbor was their CFO, golf and drinking buddy. Unfortunately, at times it's who you know and what they know. 

[AUDub 11,784]

Why do y’all hate capitalism. 

[AU9377 5,924]

Another example

https://www.11alive.com/article/news/health/congressional-hearing-insurance-reform-mattie-mckoy/85-dc56d856-ee27-4b27-a4b0-6e95b11507b4

[AUBwins 10,257]

I don't think insurance should be able to even deem what's medically necessary over a doctor asking for it.  They know their patients and if agree to do procedure, then so be it.

[homersapien 12,172]

Can't wait to see the details of (any) Republican healthcare plan.

At first, Trump said he would abandon the ACA, then he said he would make it better - "much much" better.

 

Edited July 25 by homersapien