U.S. opens UnitedHealth antitrust probe

https://www.wsj.com/health/healthcare/u-s-launches-antitrust-investigation-of-healthcare-giant-unitedhealth-ff5a00d2

by moose_man • 2 years ago

525 243 2 years ago

wsj.com

moose_man• 2 years ago

https://archive.ph/meOGZ

stop503• 2 years ago

I sense a new glauckomflecken video.

LordDragonfang2• 2 years 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".

NickC253• 2 years 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.

stop503• 2 years 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.

athenot• 2 years ago

For those not familiar, here is the one on Optum & United Healthcare:

https://www.youtube.com/watch?v=_khH6pZnHCM

John23832• 2 years ago

“Jimothy, when you make enough money, you get to write the laws.”

mindslight• 2 years 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?

throwway1203855• 2 years 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• 2 years ago

Sounds like the pitch to investors.

kurthr• 2 years 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!

0xbadcafebee• 2 years ago

If only there were some way to give everyone in a country necessary and preventive health care regardless of whether they could pay for it or not. Like imagine a developed nation with health care for everyone? Where even the poor can have necessary medical procedures, medicine, etc without having to be buried under medical debt? Lol what a pipe dream

nojito3• 2 years ago

People think that the insurer will try to keep costs down, but in fact, if prices go up they can charge more for insurance

This isn't really how they make money. Insurers make their profits by limiting the amount that they have to pay out.

The reason why owning both the care provider and the insurer is wrong is that it makes denying or "moving care" to less costly locations easier.

roenxi6• 2 years ago

It is interesting to draw a comparison with food. Practically speaking we can't go 24 hours without food, it is essential. Most people are totally dependent on others to provide their food; look at any city - the population density is too high for people to grow their own food. The food providers have no inherent incentive to make food cheap. It is totally against their interests. A shallow look at the situation suggests food providers should be able to squeeze people until all the money goes to farmers. But that isn't what happens, food is actually absurdly cheap and available given how important it is and how much needs to happen to produce it.

The situation with insurers is similar. If there was a real market that people could enter, competitive pressure would force them to be cheap. If the market was, hypothetically, choked by regulation then they'd be in a great position to charge absurd prices.

Market incentives are odd beasts. It is technically against the interests of the insurers to negotiate lower prices - unless they are competing with other insurers. Then it is in their interests to offer fair prices.

(if it isn't clear, I think I'm agreeing with you)

rapatel04• 2 years ago

This is one of the unintended consequences of Obamacare. The act mandates that administration is a fixed percentage of the revenue. Effectively this created the same perverse incentive as cost+ contracts that have hobbled the DoD. There is no incentive to keep costs down.

Value based care models are however super effective when properly implemented. Look at Kaiser Permanente. Infinitely better than the alternatives.

throwway1203855• 2 years 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.

reaperman• 2 years ago

stopped by the SEC

Seems like it would be more appropriate for the FTC to step in rather than the SEC?

nocoiner• 2 years ago

CVS Caremark is also in on the scam. UHC seems quite clearly to be the good cop - low deductibles, wide network, good coverage - and CVS Caremark is the bad cop who changes my drug availability month to month, makes me jump through prior authorization hoops that go nowhere, and randomly covers or refuses to cover my kids’ ADHD medicine on a whim. So as soon as we find a medicine with availability, that works, CVS decides to terminate coverage and we - me, my wife, our kids, their doctor, the pharmacist - all start again from square 1.

I switched jobs recently and despite having a drug regime that worked well for me over an extended period and was also cost effective, CVS denied coverage (and required prior authorizations, that were all denied) for virtually every component of my prescription care. Now, about three months after the switch, it’s probably back up to 85%+ of what it was before, but there was a lot of bureaucracy between then and now - and all due to a change that was really purely administrative in nature.

Frustrating.

lotsofpulp7• 2 years ago

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.

How about Kaiser Permanente? They have been a vertical healthcare provider/insurance organization for many decades. You pay Kaiser premiums, you see Kaiser doctors, and you get your medicine from Kaiser pharmacies.

t-writescode• 2 years ago

Kaiser is an HMO, which is a different style of operating vehicle.

throwway1203855• 2 years ago

Kaiser directly owns the provider arm. In my experience they operate totally differently from UHC. Many of their plans require you to use their provider, so you're basically prepaying for medical care from them.

UHC is notionally a PPO, but because Optum is owned by the same parent company and Optum is buying up all the providers, they're slowly becoming an HMO by monopoly. They play off of each other in any dispute.

I've had better experiences with Kaiser and had a family member who worked for them for a couple of decades.

peterlada• 2 years ago

It needs to be taken over by the government

NickC253• 2 years 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.

AuryGlenz• 2 years 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• 2 years 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. ;)

bearjaws3• 2 years 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.

mywittyname• 2 years ago

If people knew half of how consolidated their treatment was they would riot.

My partner deals with claims denials for care providers and if someone wrote a book on the stuff she's seen happen, I genuinely think it would be akin _The Jungle_ for modern audiences in terms of cultural impact.

oogali2• 2 years ago

I’ve been getting exposure to this space and the backend systems that drive it. It is mind-bogglingly dysfunctional.

Aphyr recently provided a limited window[1] into the level of dysfunction that happens with one of these behemoths that are the result of 100+ mergers, acquisitions, spinoffs, and joint ventures.

I feel terrible for the providers who have to try to navigate these antics.

In my opinion, all of this contributes to two primary “bad” things: 1) increased rates of retirement from older physicians who don’t want to deal with this anymore (despite wanting to continue practicing for 5-10 more years), and 2) consolidation of physician practices into larger entities as a way of coping which inevitably leads to the entity being acquired by a hospital and absorbed into another behemoth of an organization.

Both make it hard for individuals to receive consistent, quality care.

1: https://aphyr.com/posts/368-how-to-replace-your-cpap-in-only...

not2b2• 2 years ago

Yep. I have UHC through work. I'm on an expensive medication and UHC requires that I order it through Optum, so they keep more of the money. At least neither of the doctors I usually see work for them, so I don't have that conflict.

joncp• 2 years ago

And has Optum conveniently forgotten to ship refills, but only for the expensive drugs? That happened to my wife on multiple occasions.

Or maybe they've rejected refill requests until right before your supply runs out, such that you have to go days without your meds while the new supply is shipped?

Optum is the shadiest shitshow I've ever dealt with.

joe_the_user• 2 years ago

If people knew half of how consolidated their treatment was they would riot.

Most Americans experience first hand how horrible health care here is. No one can get upset at whatever little details are involved, however 'cause it's beyond them. Especially, you won't get people excited about more competition in a field where markets and competition seem neither logical nor have shown any benefit.

The complex referral system you describe basically results in turning regulated monopoly behavior into unregulated monopoly behavior. And this is the upshot of breaking up the original, regulated monopoly Blue Cross/Blue Shield, which provided adequate insurance in America's "Golden Era". Which to say that, imo, "restoring the free market" isn't a useful action in this mess. State controlled medicine is essentially the only solution to the already partly collapsed US health care system.

cyanydeez• 2 years ago

the healthcare complex employs millions. all these people would lose jobs.

so there's really zero political will to crack the monolith, and why things like Obama care go forward, because they're bandaids.

then there's the who employer leverage that businesses live having to immobilize a significant portion of their work force.

it's absolutely not complicated to understand why nothing has moved the needle.

oatmeal12• 2 years ago

Which to say that, imo, "restoring the free market" isn't a useful action in this mess. State controlled medicine is essentially the only solution to the already partly collapsed US health care system.

I don't trust the US government is competent enough to run healthcare. If it can do better than the existing system, let it create a new voluntary, unsubsidized insurer, free of the BS rules it has created. Competition is the source of quality and low prices. Any monopoly is an invitation for poor quality and high prices.

thatfrenchguy• 2 years ago

Most Americans experience first hand how horrible health care here is

I mean, no, most Americans are just upset about cost-sharing, most providers in the United States are pretty good and have pretty good facilities and equipments.

You can have systems that are mostly privatized (cough, France) that are better regulated than the United States, but that'd mean doctors would get paid less money & upper class folks would likely get worse care

bearjaws3• 2 years ago

Oh I don't disagree that the system is fundamentally broken, but we clearly need to attack from all angles.

echelon2• 2 years ago

State controlled medicine is essentially the only solution to the already partly collapsed US health care system.

But wouldn't government control and subsidy lead to the same malinvestment and cost explosions as college tuitions?

Wouldn't fierce competition at all levels be a good thing?

Why not force insurers to cover everything up to a set cost on a per-disease basis? That is, let patients spend a set allowance before forcing them to use in-network?

Why not adapt upfront cost estimates? Allow overages, but if a hospital goes consistently over estimate, then they get penalized?

Allow patients to access cheaper doctors and services if they waive their rights to medical malpractice lawsuits.

Give patients cheaper healthcare for demonstrable good health practices (taking into account diseases and existing conditions).

Gibbon1• 2 years ago

Most Americans experience first hand how horrible health care here is.

The little people and not so little people experience how horrible it is. All the big people get the platinum plated VIP treatment. And it's a great source of nomenklatura make work jobs for them.

Anecdote: Friend worked for a billionaire. Had a seizure at the office and ended up in the ER and the head of neurology department came down to check on him.

throw109205• 2 years ago

Which to say that, imo, "restoring the free market" isn't a useful action in this mess. State controlled medicine is essentially the only solution to the already partly collapsed US health care system.

That's a wild claim that is not only completely unprovable, but self-inconsistent. We're in this mess because of the failure of the state to create (and enforce) good regulation to begin with, and you're proposing that we move the healthcare system into the state? Pure insanity.

rainsford• 2 years ago

That kind of extractive, anti-consumer business model would be worth going after in any industry, but it feels especially bad in health care. Most health care isn't optional for the patient, and of course the more non-optional the care is the more expensive it tends to be. And serious health problems are both rare and incredibly stressful for the patient. Someone with cancer is going to have no experience shopping around for oncologists and will be willing to pay almost anything not to die.

It's almost the worst possible scenario for consumer driven free market dynamics. My personal opinion is that giant health-care conglomerates probably shouldn't exist at all. But if they do, they should be subject to much higher standards when it comes to things like antitrust than regular companies.

oogali2• 2 years ago

Wait until people catch on to the behemoth that is CVS Health…

FireBeyond6• 2 years ago

Oh, and I love where my insurance would cover my prescriptions from CVS in Washington, but when I was down in California needing steroids and anti-inflammatories urgently for my gout, they would not cover them there (and I'd made the apparently idiot assumption of having the urgent care physician send the scripts to a nearby CVS because I thought they'd be covered. Nope. Not even "out of network" - I ended up paying out of pocket and arguing for reimbursement.

tacticalturtle• 2 years ago

Isn’t this just how HMO’s work? It’s not a PPO, you’re supposed to have the majority of your care managed within the large organization. Kaiser Permanente is another one.

In theory it makes sense - by keeping everything in network there’s no constant negotiation over reimbursement rates.

But the problem is there aren’t many competitive HMOs, and we have a healthcare system driven by employment, so you can’t switch to a new HMO if you’re unsatisfied by your current one.

Edit: My point is that it’s not a conflict of interest to be routed through the UH network - that’s the entire point of an HMO vs a PPO. The idealized goal is that you have a coordinated team of providers across the organization.

pierat• 2 years ago

Basically, most forms (including ours) of capitalism turn into a oligopoly where each oligo-member is highly vertical and controls the whole narrative.

Another word for this would be corporation-states.

Amazon is another example of this. So is Google. So is Apple.

It's high time that government steps in and breaks these 'too big to fail' corpo-states up into actual competing interests that, in the end, do better for the citizenry. Cause each corporation is a dictatorial 'state' acting in opposition to our elected government, and much of our monopoly laws, either in spirit or in application.

akeck• 2 years ago

This is like Luxottica owning optometrists offices, eyewear providers like Lenscrafters, and Eyemed vision insurance.

earth2mars2• 2 years ago

Feel like you also explained the Apple walled garden. You pay 30% tax or no entry. Regulation need to be passed to change adapter port. Things won't work if you aren't in the ecosystem. And they cost a buck for Mediocre service

earth2mars2• 2 years ago

biggc• 2 years ago

On paper this seems similar to how Kaiser operates. AFAIK Kaiser is generally well-liked by its members, why is UHC so terrible?

I guess UHC doesn't own the hospitals?

markus922• 2 years ago

Kaiser is non-profit, that might change the incentives?

fnordpiglet• 2 years ago

Rioting isn’t covered under the insurance terms and conditions so no one can afford to do so.

ars• 2 years ago

Isn't this basically how an HMO works? I've heard those have lower costs and patients seem to like them.

What's different with United?

toast0• 2 years ago

I've been with Kaiser in Northern and Southern California. But not really with other HMOs.

I think the difference is Kaiser (in most places) is really a closed system; if you're with Kaiser, you go to Kaiser facilities for everything, as long as you're in the service area. If you're not with Kaiser, you don't go to Kaiser facilities, other than the emergency room maybe. Everyone you interact with is a Kaiser employee or contractor. You don't get recommended care that won't be covered, you don't get treated by someone who isn't in network, you show up, you pay your copay, and that's it, you're done.

For HMO plans with other providers, it seems like the doctors are often independent; you have to stay in network, but you still have to deal with network BS like this office is in network, but only some of the doctors. There's not a Blue Shield medical center with doctors, specialists, and a pharmacy at one location.

yborg• 2 years 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.

nradov9• 2 years ago

It's important to understand the factors driving consolidation in the healthcare industry as this goes beyond UnitedHealth Group. Everyone is sort of gradually converging on a "payvider" model like Kaiser Permanente with everything under one parent corporation. Payers and providers have been merging for years in order to gain more negotiating power over claim reimbursement rates. Regulatory compliance issues and IT costs are also killing off small, independent medical practices. In many regions a few large health systems now dominate the market. So, the only way for payers to hold down costs is to build up captive provider organizations where they can drive some operational efficiencies and economies of scale.

bogota• 2 years ago

I’m sick of paying 5k a year myself and close to 20k counting my employer for a doctor to see me for 20 minutes, ignore everything i say, and then prescribe some shit without explaining anything.

Additionally seeing how my wife is treated by doctors makes me feel physically sick. I have no respect for the medical field

garyiskidding• 2 years ago

Thanks for breaking it down, especially for people outside America.

sensanaty• 2 years 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?

rapatel04• 2 years 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• 2 years ago

US pharmacy outage triggered by 'Blackcat' ransomware at UnitedHealth unit, sources say

https://www.reuters.com/technology/cybersecurity/cyber-secur...

(https://news.ycombinator.com/item?id=39524514)

Blackthorn• 2 years 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• 2 years ago

Do Discover/Capital One next.

codegeek2• 2 years 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• 2 years 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• 2 years 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.

SlightlyLeftPad3• 2 years ago

A-f**ing-men

whoitwas2• 2 years ago

I don't think it's outdated. It was always designed to steal money. It's an obvious inefficiency in the system.

FireBeyond6• 2 years 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• 2 years 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• 2 years 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• 2 years 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• 2 years 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.

burkaman2• 2 years ago

It is absolutely false advertising and probably illegal, and it's not just you: https://jacobin.com/2024/01/health-insurance-giants-companie....

There has been some congressional interest (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.

sabujp• 2 years ago

There's also this : 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• 2 years 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• 2 years 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-...)

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• 2 years 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.

SlightlyLeftPad3• 2 years ago

Yes

burkaman2• 2 years 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• 2 years 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• 2 years 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.

lvl102• 2 years 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• 2 years ago

Can you guide me where I can read up more on this?

TheAceOfHearts• 2 years 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.

xyst3• 2 years 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• 2 years 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.

nradov9• 2 years 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

droopyEyelids• 2 years ago

What is and is not covered is set by your employer. That is the “plan design” they either choose entirely (for self funded plans) or pick a group’s plan to join (group plans)

The surprise third party provider bills are kind of a separate issue, in that it was a scam every insurance company did. we’re mostly protected by the “no surprises act” that went into effect jan ‘22

rqtwteye5• 2 years ago

"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."

I always wonder how a normal person is supposed to figure out stuff like this. I suspect these traps are set intentionally to squeeze more money out of people.

xyst3• 2 years ago

Because most people give up or forget after the first round of phone calls. It's more profitable to deny claims initially. Patient either forgoes care or pays out of pocket. Insurance company keeps the premium from customer.

lotsofpulp7• 2 years ago

As of Jan 1, 2022, the No Surprises Act requires all healthcare providers that work in a hospital to be considered to be in network if the hospital is in network. And also, all emergency healthcare is considered in network even if the hospital or doctors or labs are not in network.

mildavw• 2 years ago

I had an out of network emergency room visit with a kidney stone once while covered by a $1,000/month UHC platinum plan. When the bills arrived I stupidly paid them thinking it’d be easier to just file the claim for reimbursement from UHC on my own. After two years of submitting forms, exchanging letters, and hours of phone calls, I just gave up. It’s hard for me to consider their business as anything but an outright scam.

theGnuMe• 2 years ago

The insurer is playing games here.

Emergency care (ER care) is required to be covered even if it is out of network. So the CT scan should have been covered.

Also if this was post 2021 there is the no surprises act that applies as well. This is when you go to an in network facility and out of network providers are staffing it.

https://www.cms.gov/newsroom/fact-sheets/no-surprises-unders...

nonethewiser2• 2 years ago

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.

I can’t understand how this is even legal. I know its a somewhat normal occurrence but you wouod think people could at least easily win a lawsuit and get them to sure-up their policies.

Its probably ignorance and not malice but it doesn’t really matter. It basically just amounts to a scam.

quasse• 2 years ago

It's no longer legal as of Jan 1, 2022 (part of the Consolidated Appropriations Act, 2021).

If you want a list of the real worst of the worst Senators, go look at the people who voted against making this a law.

codegeek2• 2 years 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.

gazpacho4• 2 years 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.

ClumsyPilot2• 2 years 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• 2 years ago

Yes, I think the better wording is: there's no efficient market/competition going on

throw109205• 2 years ago

Free market produces Oligopolies, monopolies, cartels and collusion.

You conflated two different uses of the word "free market" - one which is correctly described as "laissez-faire", and the other one, which is the one that everyone actually uses (including gazpacho, the user you were responding to). With very few exceptions, nobody on HN argues for laissez-faire capitalism - and "Oligopolies, monopolies, cartels and collusion" only happens in laissez-faire capitalism. In other words, you made a strawman argument.

whoitwas2• 2 years ago

If you ever tried private insurance in the US, you might disagree. In my experience, it's impossible to use. The only option if you want health care in US is to be employed.

gazpacho4• 2 years ago

I’m saying we should change that

gazpacho4• 2 years ago

But also: could you clarify what do you mean by private insurance? You can buy insurance from Blue Cross, Cigna, United, etc on healthcare.gov. It’s the same providers you get through your employer, the only difference is that it’s the government negotiating (kinda) and you choosing instead of your employer doing both.

xyst3• 2 years ago

end private health insurance. single payer system needed.

SlightlyLeftPad3• 2 years 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.

om154• 2 years ago

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

claytongulick• 2 years 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

[2] https://diabetes.org/newsroom/press-releases/new-american-di...

[3] https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast...

[4] https://www.sciencedirect.com/science/article/pii/S277306542...

ejb9992• 2 years 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).

gorbachev• 2 years ago

And who do we have to blame for that? Other big corporations who optimize shareholder value over people's well being.

ejb9992• 2 years 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.

boringuser2• 2 years ago

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

aquaphile2• 2 years 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• 2 years ago

And all the private equity firms that created some of these monsters.

U.S. opens UnitedHealth antitrust probe

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