Chickens roosting on an open fire

by liberal japonicus

This

Just over a year before United Healthcare CEO Brian Thompson was murdered this week in Midtown Manhattan, a lawsuit filed against the insurance giant he helmed revealed just how draconian its claims-denying process had become.

Last November, the estates of two former UHC patients filed suit in Minnesota alleging that the insurer used an AI algorithm to deny and override claims to elderly patients that had been approved by their doctors.

The algorithm in question, known as nH Predict, allegedly had a 90 percent error rate — and according to the families of the two deceased men who filed the suit, UHC knew it.

There have been other reports, in particular, the fact that "deny," "defend," and "depose" was carved on the shell casing of the bullets. It seems a little too neat, but if it is the case, judging from the shared posts in my facebook, it wouldn't take a lot for crazy people to think they are doing a public service. Discuss.

 

Comments

[liberal japonicus]

This is interesting

https://www.lawyersgunsmoneyblog.com/2024/12/the-revolution-will-not-be-livestreamed

I remember that in the 1997 film As good as it gets, the following exchange occurs

Carol Connelly: Fucking HMO bastard pieces of shit!
Beverly Connelly: Carol!
Carol Connelly: [smiles sheepishly] I'm sorry.
Dr. Martin Bettes: It's okay. Actually, I think that's their technical name.

And one article reported that everyone in the theatre started cheering, 27 years later, it's not surprising that this continues to be an issue, especially since virtually nothing has been done to rein this kind of behavior in.

[hairshirthedonist]

This puts a new twist on "FIRE sector."

[wj]

If you support people who rile up their supporters demanding vigilante "justice," why is it a surprise that the mindset spreads?

Leopards. Faces.

[Michael Cain]

Most of 40 years ago when we moved to Colorado we encountered one of the first of the real HMOs: Kaiser Permanente. At the time, KP was the most popular employer health insurance choice and had the highest satisfaction ratings.

Four decades on, KP still has the highest satisfaction ratings. Enough so that much of their competition is other giant unified healthcare providers that offer everything from PCPs up to specialists and their own hospitals. None of them have taken the step that makes Kaiser unique, since Kaiser is not only the care provider but the insurer. I suspect that patients of big outfits like Banner Health get better treatment from the insurers than little practices.

[wj]

Imaging chestnuts roasting on this opem fire
https://apod.nasa.gov/apod/ap241207.html

Oh wait, there's video!
https://plus.nasa.gov/video/nasa-rocket-engine-fireplace/

Enjoy

[Snarki, child of Loki]

Yes, it's probably a naive idea, but I always wondered if it would make sense to require health insurers to bundle "life insurance" as well, so they would have to make a big payout if one of their insured dies, and they would have a strong incentive to keep them alive.

[nous]

Could turn out to be the Assisted Dying Bill: French Revolution Edition.

[Tony P.]

When health insurance CEOs start hiring bodyguards, will they offer them health insurance?

--TP

[wj]

Depends on whether the guards work for the health insurance company, for a security company, or for the CEO personally. Company employees will get health insurance automatically. Security company employees probably ditto.

Personal employees? Who knows?

[Pete]

Lead allergy. Pre-existing condition. Claim Denied.

[novakant]

Here's a good article:

https://www.newyorker.com/news/the-lede/what-the-murder-of-the-unitedhealthcare-ceo-brian-thompson-means-to-america

As bad as the NHS can be, it's still galaxies away from the US system.

[liberal japonicus]

I'm really curious if the author chose the title. I suspect that the subtitle (which is in the link) was the author's title and the first part was the editors.

I thought this vox article was interesting
https://www.vox.com/policy/390031/anthem-blue-cross-blue-shield-anesthesia-limits-insurance

The whole system is shot thru with rent-seeking.

[liberal japonicus]

I feel like I need to post this reddit thread, cause it popped up as well

https://www.reddit.com/r/medicalschool/comments/1h8h408/vox_can_go_to_hell_a_big_insurer_backed_off_its/

[bobbyp]

The whole system is shot thru with rent-seeking.

Indeed. We have constructed a health care system where to not be rent seeking is to entertain financial failure, and the "health" insurnace companies cream profit off the top...the higher the costs, the higher the premiums, the higher the profit.

In a rational world this would be laughable if it were not so socially tragic.

[hairshirthedonist]

Four decades on, KP still has the highest satisfaction ratings. Enough so that much of their competition is other giant unified healthcare providers that offer everything from PCPs up to specialists and their own hospitals. None of them have taken the step that makes Kaiser unique, since Kaiser is not only the care provider but the insurer.

I'm no student of healthcare or health insurance, but this seems to me to be, if not the best possible model, much better than the prevailing one that exists now. Why is Kaiser unique rather than one of many of its kind?

[wj]

Why is Kaiser unique rather than one of many of its kind?

At a guess, history.

Kaiser was set up originally as a service for a construction project. That is, essentially a non-profit. Other HMOs were created as HMOs, with profit making intentions baked in.

[hairshirthedonist]

https://baltimorefishbowl.com/stories/baltimore-valedictorians/

If you follow the link and scroll down the page to find the last valedictorian mentioned, you might find a familiar face and name, depending on how closely you're following the latest news.

[russell]

it would appear the young man had had enough.

sad all around, for everyone.

[GftNC]

Well, in a time of almost no good news, I can still smile at Rupert Murdoch's disappointment as he loses the opportunity to ensure his company remains, even after his death, the world's premier and most influential purveyor of rightwing trash propaganda. The involvement of William Barr was just the icing on the cake. However, he could still win on appeal:

https://www.theguardian.com/media/2024/dec/09/rupert-murdochmedia-empire-children

[Michael Cain]

Kaiser was set up originally as a service for a construction project.

As a consequence, Kaiser (the construction and shipbuilding company) recognized that it was in their interest to have all but the most specialized care providers be Kaiser employees. Working at Kaiser facilities, seeing only Kaiser employees. That's still true* today: Kaiser providers only see Kaiser members (ie, people with Kaiser insurance).

I recall talking to a Kaiser doc after we started using them. She said that sure, she could earn somewhat more in a private practice. But as a Kaiser doc, there was someone she could call to take care of all of the complications private practices face. Who covers when she's sick or on vacation, who manages the supplies/cleaning/whatever, who deals with the insurance.

* At least in Colorado the details are different today. There's a separate company that employs the care providers, but that company sells their services exclusively to Kaiser at agreed-to rates.

[wj]

One other difference is (or was, back when I worked in Kaiser's IT department) that the CEO was always an actual MD. Not a guarantee of being patient-focused. But far more likely than an MBA.

[GftNC]

Apologies, my 06.38 should have been in the open thread, not this one.