NYC assassination news thread - Please no politics (1 Viewer)

[Dr. Octopus]

I think there's part of me that was genuinely surprised by a NY Times facebook post calling the CEO a ""Mass murderer for profit" would get almost 2,000 "likes". Maybe that's just me being dumb and not factoring in that maybe 1,800 of those are bots or something.

Even if all 2,000 likes are legitimate - how does that number compare to the U.S. Population or even just the entire Facebook population?

It may seem like a big number, but's its still a fringe of the general population.

We spend way too much time giving the fringe what they want: Attention.

Also a NYT Facebook page is going to attract a like-minded crowd for the most part, so it really shouldn't be that surprising to see an echo chamber type of response there,

 

[Andy Dufresne]

College, so called elite or otherwise, have always bred idealistic extremism.

I'd like to see specific data that supports anything different than what's always been happening there.

Social media and hot take media has certainly made these views more apparent and intentionally polarizing, but other than all the endless pontificating, I'd like to see in what ways these things have specifically changed. A kid coming unhinged and killing somebody... That's new? That's a sign of the elite apocalypse?

It's likely not measurable but it could possibly be argued that the extremism has heretofore not been as one sided AND vitriolic.

 

[Captain Cranks]

You're basically saying that you either agree with my views on a position, or else you're either just trying to get a rise out of people or you're ignorant,

You must be new around here.

 

[El Floppo]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

In what way are you close to it?

Don't want you to get yourself in trouble... But I'm sure we're all curious to hear.

 

[Dr. Octopus]

Honestly, I thought corporate boards, law firms and legislatures were the eventual landing spots for the elite university types, lots of conservative Biffs and Buffies.

They get there eventually after being young and idealistic for a while.

 

[rockaction]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Hey, abrunn1133, welcome to the FFA, man.

 

[CletiusMaximus]

It feels like half this forum is instigators and the other half has its head in the sand.

I'm not looking to pick a fight here, I respect much of what you say on here, but this seems a bit hypocritical.

You're basically saying that you either agree with my views on a position, or else you're either just trying to get a rise out of people or you're ignorant,

This is basically right, but I would put it a little differently. I think a lot of people are in denial about what has been happening in this country over the past decade or so. "Ignorant" comes close to capturing what I'm saying, but it's not quite right. I think people understand, on some level, that that is not how things are supposed to be, but nobody wants to acknowledge it because there's no easy fix.

The people who want to shoot folks like you and me in the back are not weirdos living in their parents' basement. They work on my campus, they write the newspaper articles I read, and they post in this forum with the rest of us. I don't need any more data points for this hypothesis. This dynamic has played out exactly the way that I predicted it would. Again, the receipts are right there. I can't force anybody to look at them, but i know they're there.

It strikes me as overly dramatic and a bit hysterical to claim there is a popular movement to shoot people like you and me in the back based on this incident and to refer us to the thread about punching Nazis as 'receipts.' Fifty years ago we had a sitting president assassinated followed 5 years later by a sitting senator and MLK in the same year. Malcom X in '65. Fred Hampton and the Black Panthers killed in Chicago. Unarmed students were shot and killed at Kent St and a bomb planted in a university lab in Wisconsin killed a researcher. Gen X and Millenials have never seen social violence levels remotely approaching what their parents and grandparents experiencd. We went to war. We had a string of highly controversial supreme court decisions that changed our society in fundamental ways. Yet many today look back on the 50s and 60s as the pinnacle of our country's history, a time of moral order and wealth like none other. I'm pretty far from ascribing any big picture significance to this CEO murder but am willing to see it play out a bit befote coming to any grand conclusions. My impression is that Mangione's generation is extremely busy taking action on social media in between taking turns on their Clash of Clans app but I don't see them recreating the Chicago DNC riots or anything close to it anytime soon.

 

[Sammy3469]

IMO...

A lot of our nation's shouting at each other is a result of trying to make sense of nonsense.

Why did "that person" on "your side" do that? Because that's what "your side" believes of course!

Why did that mass shooter kill all those people? Because you gun nuts love guns of course!

Why did this anti-capitalist shoot that CEO in the back? Because you lefties hate business of course!

But the "of course" part is just not true. Any societal sunset will have it's fringes and, worse, lunatics. They leave the reasonable among the masses holding the bag and having to answer for their extreme and anti-social behavior.

But again, that's just attempting to make sense of nonsense. Let's call it like it is here - murdering a businessperson in broad daylight is crazy, antisocial, and abnormal behavior. And just because there are avenues (i.e. social media) available to those like-minded to voice their support doesn't necessarily mean that it's now being accepted as "normal".

This person is deranged and the proof is in the actions. He may have had a privileged upbringing and been provided an Ivy League education and advantage - but that doesn't preclude mental illness. I had a cousin that fits this description; he grew up with wealth and was very intelligent and fun. He also, unfortunately, had mental illness that resulted in institutionalization and ultimately suicide. How could he do that given all the advantages he had? Don't try to make sense of nonsense.

Personally, would I like to see the rhetoric tuned down and the decorum turned up in our society? You better believe it. But I'm not going to make blanket value judgements on the "other side" just because of the actions of their lunatic fringe.

FWIW...I think that's a little hard for folks. Whether its depression, a bad back, or immuno disease, most everyone know someone close to them living in pain. Frankly the more topical part of this entire story is how to help stopping someone you know from destroying themselves (and others) dealing with these issues. This isn't trying to rationalize what he did, but how you should be helping those you love dealing with similar physical or mental pain. Hopefully, I'll never understand how someone spirals like this in my personal life, but I do want to understand if there were signs he was spiraling (besides random Reddit posts). In stark terms if my 13 year starts having issues, I'd like to know what I should be doing besides yelling.

 

[Gjallarhorn]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

 

[El Floppo]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Sorry for your loss, man.

And thanks for the info.

 

[El Floppo]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

 

[the moops]

The people who want to shoot folks like you and me in the back are not weirdos living in their parents' basement. They work on my campus, they write the newspaper articles I read, and they post in this forum with the rest of us. I don't need any more data points for this hypothesis. This dynamic has played out exactly the way that I predicted it would. Again, the receipts are right there. I can't force anybody to look at them, but i know they're there.

The people that want shoot you is a tiny fraction of a percent. Yes, a tiny fraction is too many, but you are really hamming it up in here. And that tiny fraction are indeed weirdos. They may not live in their parents basement but they are most certainly not mainstream. It is also not a one side thing no matter how much you want it to be.

 

[Gjallarhorn]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

 

[El Floppo]

It feels like half this forum is instigators and the other half has its head in the sand.

I'm not looking to pick a fight here, I respect much of what you say on here, but this seems a bit hypocritical.

You're basically saying that you either agree with my views on a position, or else you're either just trying to get a rise out of people or you're ignorant,

This is basically right, but I would put it a little differently. I think a lot of people are in denial about what has been happening in this country over the past decade or so. "Ignorant" comes close to capturing what I'm saying, but it's not quite right. I think people understand, on some level, that that is not how things are supposed to be, but nobody wants to acknowledge it because there's no easy fix.

The people who want to shoot folks like you and me in the back are not weirdos living in their parents' basement. They work on my campus, they write the newspaper articles I read, and they post in this forum with the rest of us. I don't need any more data points for this hypothesis. This dynamic has played out exactly the way that I predicted it would. Again, the receipts are right there. I can't force anybody to look at them, but i know they're there.

It strikes me as overly dramatic and a bit hysterical to claim there is a popular movement to shoot people like you and me in the back based on this incident and to refer us to the thread about punching Nazis as 'receipts.' Fifty years ago we had a sitting president assassinated followed 5 years later by a sitting senator and MLK in the same year. Malcom X in '65. Fred Hampton and the Black Panthers killed in Chicago. Unarmed students were shot and killed at Kent St and a bomb planted in a university lab in Wisconsin killed a researcher. Gen X and Millenials have never seen social violence levels remotely approaching what their parents and grandparents experiencd. We went to war. We had a string of highly controversial supreme court decisions that changed our society in fundamental ways. Yet many today look back on the 50s and 60s as the pinnacle of our country's history, a time of moral order and wealth like none other. I'm pretty far from ascribing any big picture significance to this CEO murder but am willing to see it play out a bit befote coming to any grand conclusions. My impression is that Mangione's generation is extremely busy taking action on social media in between taking turns on their Clash of Clans app but I don't see them recreating the Chicago DNC riots or anything close to it anytime soon.

The 60s certainly... and starting in the communist revolution in the early 20th c as well. No idea about 19th c, but Kings College (aka Columbia) produced revolutionary Alexander Hamilton in the 18th.

 

[matttyl]

I think there's part of me that was genuinely surprised by a NY Times facebook post calling the CEO a ""Mass murderer for profit" would get almost 2,000 "likes". Maybe that's just me being dumb and not factoring in that maybe 1,800 of those are bots or something.

But it was notable I thought.

And maybe this is more a wealth inequity thing. We talked about this a while back on the PSF where some popular posters thought it was great or :shrugged: at protestors bringing a Guillotine to Jeff Bezos' home for a protest. https://forums.footballguys.com/thr...ront-of-jeff-bezos-home.786326/#post-22813270

Was interesting too that the less talkative majority thought it was a bad thing.

But maybe folks are right and this is too political.

I think the insider trading allegations really angered people too in addition to being the CEO of a health insurance company.

I read something that said all health insurance back in 1970s was non-profit. Can someone confirm?

Not all, but most. Aetna (for profit company) for instance, has been selling major medical insurance policies since the 1950s. United (obviously the company in this story) started in the 1970s. I can get more into it if you like, but it’s kinda boring. The long and short of it is that it’s been an ever evolving marketplace since roughly the 1930s (and only became a thing once the cost of healthcare started increasing).

 

[thecatch]

The people who want to shoot folks like you and me in the back are not weirdos living in their parents' basement. They work on my campus, they write the newspaper articles I read, and they post in this forum with the rest of us. I don't need any more data points for this hypothesis. This dynamic has played out exactly the way that I predicted it would. Again, the receipts are right there. I can't force anybody to look at them, but i know they're there.

The people that want shoot you is a tiny fraction of a percent. Yes, a tiny fraction is too many, but you are really hamming it up in here. And that tiny fraction are indeed weirdos. They may not live in their parents basement but they are most certainly not mainstream. It is also not a one side thing no matter how much you want it to be.

I've seen a bunch of tenured Ivy league faculty expressing these views on Twitter in the last week. They certainly aren't the silent majority, but this isn't a bunch of anonymous online trolls either.

 

[Gjallarhorn]

It feels like half this forum is instigators and the other half has its head in the sand.

I'm not looking to pick a fight here, I respect much of what you say on here, but this seems a bit hypocritical.

You're basically saying that you either agree with my views on a position, or else you're either just trying to get a rise out of people or you're ignorant,

This is basically right, but I would put it a little differently. I think a lot of people are in denial about what has been happening in this country over the past decade or so. "Ignorant" comes close to capturing what I'm saying, but it's not quite right. I think people understand, on some level, that that is not how things are supposed to be, but nobody wants to acknowledge it because there's no easy fix.

The people who want to shoot folks like you and me in the back are not weirdos living in their parents' basement. They work on my campus, they write the newspaper articles I read, and they post in this forum with the rest of us. I don't need any more data points for this hypothesis. This dynamic has played out exactly the way that I predicted it would. Again, the receipts are right there. I can't force anybody to look at them, but i know they're there.

It strikes me as overly dramatic and a bit hysterical to claim there is a popular movement to shoot people like you and me in the back based on this incident and to refer us to the thread about punching Nazis as 'receipts.' Fifty years ago we had a sitting president assassinated followed 5 years later by a sitting senator and MLK in the same year. Malcom X in '65. Fred Hampton and the Black Panthers killed in Chicago. Unarmed students were shot and killed at Kent St and a bomb planted in a university lab in Wisconsin killed a researcher. Gen X and Millenials have never seen social violence levels remotely approaching what their parents and grandparents experiencd. We went to war. We had a string of highly controversial supreme court decisions that changed our society in fundamental ways. Yet many today look back on the 50s and 60s as the pinnacle of our country's history, a time of moral order and wealth like none other. I'm pretty far from ascribing any big picture significance to this CEO murder but am willing to see it play out a bit befote coming to any grand conclusions. My impression is that Mangione's generation is extremely busy taking action on social media in between taking turns on their Clash of Clans app but I don't see them recreating the Chicago DNC riots or anything close to it anytime soon.

It took tremendous coordination and a united front against a common opponent/cause to make the dent that the civil rights activists made in the 60s. I do not see that level of coordination happening again, at least anytime soon. There are far too many competing causes at this time.

 

[El Floppo]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Thanks for that.

And ftr, I'm not trying play "gotcha" here... I have no agenda with asking, just curious.

Are the other competing companies also M&A as part of their business? I assume they are? If so, that doesn't really explain why that one shows those kind of numbers relative to others. And tbh, I have no idea about the veracity of that 2x worse rate.. very easily could be some misinformation that got picked up and spread. Also, for those of us on the other side of the insurance industry- the customers- it would be great if something positive came out of this (despite the horrific murder) I which the dialogue and actions became more than the industry's first step of taking (understandable) safety precautionary steps for its executives.. that's all the news I've heard from that side of things.

 

[need2know]

With all of the support he has gotten over the last week I am curious what the chances are that he gets a sympathetic jury

Zero chance

 

[El Floppo]

With all of the support he has gotten over the last week I am curious what the chances are that he gets a sympathetic jury

Zero chance

Do we think this goes to trial? I assume he's going to plead guilty as the evidence accumulates.

 

[beer 30]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Interesting, lets see how this plays out.

 

[uwillbsoon]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

I assume UHG purchased naviHealth because they thought it would be profitable and/or have strategic value.

Are you telling me they didn't understand why it was profitable?

And when they purchase other companies that have high denial rates (and thus are likely more profitable because they pay out less claims) they don't know that's why they're more profitable?


I know there's a lot more here, but we can't pretend UHG doesn't have an MO even when they acquire companies.

 

[Dr. Octopus]

With all of the support he has gotten over the last week I am curious what the chances are that he gets a sympathetic jury

Zero chance

I mean the video of him shooting down someone else in cold blood is not going to allow much wiggle room in the jury box - but maybe a juror will fight for some "mitigating factors" but even that seems unlikely. Luigi is almost assuredly spending a long time in prison.

 

[Gjallarhorn]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Thanks for that.

And ftr, I'm not trying play "gotcha" here... I have no agenda with asking, just curious.

Are the other competing companies also M&A as part of their business? I assume they are? If so, that doesn't really explain why that one shows those kind of numbers relative to others. And tbh, I have no idea about the veracity of that 2x worse rate.. very easily could be some misinformation that got picked up and spread. Also, for those of us on the other side of the insurance industry- the customers- it would be great if something positive came out of this (despite the horrific murder) I which the dialogue and actions became more than the industry's first step of taking (understandable) safety precautionary steps for its executives.. that's all the news I've heard from that side of things.

I understand what you are saying, and you are making a good point. There is nothing in place form a regulatory standpoint that requires companies to track and report their denial %. i am assuming that the numbers that were reported were a snapshot from a small segment of UHCs portfolio. Maybe a specific application or entity reported on the denial %. I would have to see the exact % and where it came from. I would imagine, although I am not sure I could say with certainty, that UHC is similar to other like-sized health insurance companies when it comes to denials. I can see congress having a similar question.

 

[jamny]

So I don't have to infect myself too badly, can someone kindly give me a short bio on Taylor Lorenz? Could look it up but dont want to have to wade through subjective stuff on the webs if possible.

Ultra-left Millennial WaPo writer that is a walking caricature of what one would think would be an ultra-left WaPo writer. Think Bernadette Dohrn meets Teen Vogue. Think crying on the job mixed with a sexual harassment suit against you for complimenting her shirt while she goes to HR talking about equal pay.

I hate that I share a last name with her. I keep hoping she would just go away.

 

[Joe Bryant]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Thanks. I'm sorry.

The real people part is one reason why I think we do best to keep it civil and not do the jokes as much.

 

[Gjallarhorn]

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

I assume UHG purchased naviHealth because they thought it would be profitable and/or have strategic value.

Are you telling me they didn't understand why it was profitable?

And when they purchase other companies that have high denial rates (and thus are likely more profitable because they pay out less claims) they don't know that's why they're more profitable?


I know there's a lot more here, but we can't pretend UHG doesn't have an MO even when they acquire companies.

UHG does not always purchase companies based on profitability. A lot of times companies have specific technologies, software, innovations that will benefit UHG. However, I think it is safe to assume that they purchased a theoretical company because it was either currently profitable, or it could be profitable at scale.

I cannot answer why the M&A team purchased a specific company.

I do not agree that they have an MO. They are, however, not in business to lose money, and they are beheld to a Board of Director and Shareholders. I can say that I have never directly, or indirectly seen anything related to denying claims to make more money.

 

[Stoneworker]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

This post resonates with me.

One of my closest friends and college roommate has dedicated his life to medicine. First as a career physician and now runs one of the country's largest health systems. The single most generous and caring person I've known.

He frequently laments the complexities of administrative and "business" aspects that force him to constantly triage levels of care, often on criteria other than pure medical. Many of these are judgement calls.

I have no idea the person Brian Thompson was or how he ran UHC, but the idea of murdering someone the accused doesn't know personally ostensibly because he's a figurehead of a system the kid can't possibly entirely comprehend at that age is sickening and something I will never "understand."

I understand what you are saying, and you are making a good point. There is nothing in place form a regulatory standpoint that requires companies to track and report their denial %. i am assuming that the numbers that were reported were a snapshot from a small segment of UHCs portfolio. Maybe a specific application or entity reported on the denial %. I would have to see the exact % and where it came from. I would imagine, although I am not sure I could say with certainty, that UHC is similar to other like-sized health insurance companies when it comes to denials. I can see congress having a similar question.

Isn't one of the major industry issues that denial % calculations are not standardized and/or consistently published and reported?

Therefore all of these denial numbers being bandied about lack any comparative value.

Including for prospective insured as they look to make informed choices prior to choosing a provider

 

[matttyl]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I don’t mean to speak for him, but I can attempt to answer your question (I’m an insurance agent).

Lots of the numbers I’ve seen thrown about the past week have to be taken in context. The most “shocking” number I’ve seen has been their “32% denial rate”. That number came from an online article that was only looking at individual policies purchased via the “exchanges”. The individual market is only around 10% of the total population (though KFF said it was only 15m in 2021, which would be only about 5%). Moreover, United is by no means a large player in the individual market….anywhere. KFF has a listing of the largest, second largest and third largest individual carrier in each state (again, for 2021 as most recent year) they are the single largest in Nevada only, and then the third largest carrier in 10 states (Wyoming, WV, Neb., MD, LA, Iowa, Indiana, dela., ark., and Alabama) and they range anywhere from 1-5% market share in those 10 states. Again, they are a very small player in a very small market - so taking their denial rate from it and then attempting to extrapolate it over the entire industry would be dishonest.

 

[uwillbsoon]

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

I assume UHG purchased naviHealth because they thought it would be profitable and/or have strategic value.

Are you telling me they didn't understand why it was profitable?

And when they purchase other companies that have high denial rates (and thus are likely more profitable because they pay out less claims) they don't know that's why they're more profitable?


I know there's a lot more here, but we can't pretend UHG doesn't have an MO even when they acquire companies.

UHG does not always purchase companies based on profitability. A lot of times companies have specific technologies, software, innovations that will benefit UHG. However, I think it is safe to assume that they purchased a theoretical company because it was either currently profitable, or it could be profitable at scale.

I cannot answer why the M&A team purchased a specific company.

I do not agree that they have an MO. They are, however, not in business to lose money, and they are beheld to a Board of Director and Shareholders. I can say that I have never directly, or indirectly seen anything related to denying claims to make more money.

Have you read the naviHealth lawsuit?

It's alleged they made a business decision to not deviate from naviHealth's post acute care recommendations by more than 1% because less than 1% of people appealed those decisions (this is in MA, so these are people coming off a hospital stay that are old and may need care at a nursing facility or at home). These are generally expensive claims.

However, those that did appeal, won those appeals around 90% of the time.

MA allows up to 100 days in a nursing home following a three day hospital stay. UHG's model meant patients rarely stayed more than 14 days before the denials came, regardless of what the doctor recommended. It was based on a database of around six million folks.

Now, I will agree with you that UHG is generally aloof. I know of several businesses they purchased and shut down or ignored. Unfortunately, that's not really an excuse.

As for them being beholden to shareholders, I agree that's the core problem with the US insurance industry. There's a reason non-profits generally score higher in MA Star Ratings for example.

 

[El Floppo]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I don’t mean to speak for him, but I can attempt to answer your question (I’m an insurance agent).

Lots of the numbers I’ve seen thrown about are very the past week have to be taken in context. The most “shocking” number I’ve seen has been their “32% denial rate”. That number came from an online article that was only looking at individual policies purchased via the “exchanges”. The individual market is only around 10% of the total population (though KFF said it was only 15m in 2021, which would be only about 5%). Moreover, United is by no means a large player in the individual market….anywhere. KFF has a listing of the largest, second largest and third largest individual carrier in each state (again, for 2021 as most recent year) they are the single largest in Nevada only, and then the third largest carrier in 10 states (Wyoming, WV, Neb., MD, LA, Iowa, Indiana, dela., ark., and Alabama) and they range anywhere from 1-5% market share in those 10 states. Again, they are a very small player in a very small market - so taking their denial rate from it and then attempting to extrapolate it over the entire industry would be dishonest.

Good info, thanks.

I had a feeling there was an * attached to those numbers that had gotten lost in the game of social media telephone.

That said, I'm part of that individual policy group. Yay me.

 

[BlackCrowes]

i'm for universal healthcare, and this guy should spend the rest of his life in prison

and people really look at Yelp for McDonald's?

 

[matttyl]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I don’t mean to speak for him, but I can attempt to answer your question (I’m an insurance agent).

Lots of the numbers I’ve seen thrown about are very the past week have to be taken in context. The most “shocking” number I’ve seen has been their “32% denial rate”. That number came from an online article that was only looking at individual policies purchased via the “exchanges”. The individual market is only around 10% of the total population (though KFF said it was only 15m in 2021, which would be only about 5%). Moreover, United is by no means a large player in the individual market….anywhere. KFF has a listing of the largest, second largest and third largest individual carrier in each state (again, for 2021 as most recent year) they are the single largest in Nevada only, and then the third largest carrier in 10 states (Wyoming, WV, Neb., MD, LA, Iowa, Indiana, dela., ark., and Alabama) and they range anywhere from 1-5% market share in those 10 states. Again, they are a very small player in a very small market - so taking their denial rate from it and then attempting to extrapolate it over the entire industry would be dishonest.

Good info, thanks.

I had a feeling there was an * attached to those numbers that had gotten lost in the game of social media telephone.

That said, I'm part of that individual policy group. Yay me.

With United? Just curious. Generally the individual market is dominated by “the blues”.

 

[Joe Schmo]

i'm for universal healthcare, and this guy should spend the rest of his life in prison

and people really look at Yelp for McDonald's?

Honestly didnt think yelp was still a thing.

 

[Joe Bryant]

and people really look at Yelp for McDonald's?

Yelp is sometimes used as a way to make a protest statement type thing against businesses.

 

[El Floppo]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I don’t mean to speak for him, but I can attempt to answer your question (I’m an insurance agent).

Lots of the numbers I’ve seen thrown about are very the past week have to be taken in context. The most “shocking” number I’ve seen has been their “32% denial rate”. That number came from an online article that was only looking at individual policies purchased via the “exchanges”. The individual market is only around 10% of the total population (though KFF said it was only 15m in 2021, which would be only about 5%). Moreover, United is by no means a large player in the individual market….anywhere. KFF has a listing of the largest, second largest and third largest individual carrier in each state (again, for 2021 as most recent year) they are the single largest in Nevada only, and then the third largest carrier in 10 states (Wyoming, WV, Neb., MD, LA, Iowa, Indiana, dela., ark., and Alabama) and they range anywhere from 1-5% market share in those 10 states. Again, they are a very small player in a very small market - so taking their denial rate from it and then attempting to extrapolate it over the entire industry would be dishonest.

Good info, thanks.

I had a feeling there was an * attached to those numbers that had gotten lost in the game of social media telephone.

That said, I'm part of that individual policy group. Yay me.

With United? Just curious. Generally the individual market is dominated by “the blues”.

Not United.

 

[urbanhack]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you referring to the Hollywood Firefighters’ Pension Fund filed a lawsuit accusing him of insider trading and fraud? According to the lawsuit, Thompson had sold $15 million in personally held company stock during a Justice Department antitrust investigation into UnitedHealthcare, knowledge of which he failed to disclose. When news of the investigation broke, it wiped out nearly $25 billion in shareholder value. Or was it his reported sale of $1.5 million in stock on the same day that the company suffered a ransomware attack that erased $46 billion in market cap?

 

[Gjallarhorn]

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

I assume UHG purchased naviHealth because they thought it would be profitable and/or have strategic value.

Are you telling me they didn't understand why it was profitable?

And when they purchase other companies that have high denial rates (and thus are likely more profitable because they pay out less claims) they don't know that's why they're more profitable?


I know there's a lot more here, but we can't pretend UHG doesn't have an MO even when they acquire companies.

UHG does not always purchase companies based on profitability. A lot of times companies have specific technologies, software, innovations that will benefit UHG. However, I think it is safe to assume that they purchased a theoretical company because it was either currently profitable, or it could be profitable at scale.

I cannot answer why the M&A team purchased a specific company.

I do not agree that they have an MO. They are, however, not in business to lose money, and they are beheld to a Board of Director and Shareholders. I can say that I have never directly, or indirectly seen anything related to denying claims to make more money.

Have you read the naviHealth lawsuit?

It's alleged they made a business decision to not deviate from naviHealth's post acute care recommendations by more than 1% because less than 1% of people appealed those decisions (this is in MA, so these are people coming off a hospital stay that are old and may need care at a nursing facility or at home). These are generally expensive claims.

However, those that did appeal, won those appeals around 90% of the time.

MA allows up to 100 days in a nursing home following a three day hospital stay. UHG's model meant patients rarely stayed more than 14 days before the denials came, regardless of what the doctor recommended. It was based on a database of around six million folks.

Now, I will agree with you that UHG is generally aloof. I know of several businesses they purchased and shut down or ignored. Unfortunately, that's not really an excuse.

As for them being beholden to shareholders, I agree that's the core problem with the US insurance industry. There's a reason non-profits generally score higher in MA Star Ratings for example.

I am familiar with the lawsuit. I cannot speak specifically to anything that is currently being litigated. I hope you understand this. As for the capitalism vs. socialism and state-run health insurance, that is not a topic I want to get into,

 

[mr. furley]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

I assume UHG purchased naviHealth because they thought it would be profitable and/or have strategic value.

Are you telling me they didn't understand why it was profitable?

And when they purchase other companies that have high denial rates (and thus are likely more profitable because they pay out less claims) they don't know that's why they're more profitable?


I know there's a lot more here, but we can't pretend UHG doesn't have an MO even when they acquire companies.

without knowing the specifics here, there are more reasons that companies acquire others that go beyond "profit".

could be they wanted the technology, the intellectual property, the people, the processes. could be to squelch competition. could be to prevent a competitor from purchasing, etc.

 

[GoBirds]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Thank you for sharing this. It’s good to hear from someone with real knowledge and not just what some have read where they get their news. It seems you knew him well, sorry for your loss friend.

 

[Gjallarhorn]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you referring to the Hollywood Firefighters’ Pension Fund filed a lawsuit accusing him of insider trading and fraud? According to the lawsuit, Thompson had sold $15 million in personally held company stock during a Justice Department antitrust investigation into UnitedHealthcare, knowledge of which he failed to disclose. When news of the investigation broke, it wiped out nearly $25 billion in shareholder value. Or was it his reported sale of $1.5 million in stock on the same day that the company suffered a ransomware attack that erased $46 billion in market cap?

That is one of many.

 

[Gjallarhorn]

I should also add that I think it sucks when people do not get the care they need. Full stop.

 

[uwillbsoon]

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

I assume UHG purchased naviHealth because they thought it would be profitable and/or have strategic value.

Are you telling me they didn't understand why it was profitable?

And when they purchase other companies that have high denial rates (and thus are likely more profitable because they pay out less claims) they don't know that's why they're more profitable?


I know there's a lot more here, but we can't pretend UHG doesn't have an MO even when they acquire companies.

UHG does not always purchase companies based on profitability. A lot of times companies have specific technologies, software, innovations that will benefit UHG. However, I think it is safe to assume that they purchased a theoretical company because it was either currently profitable, or it could be profitable at scale.

I cannot answer why the M&A team purchased a specific company.

I do not agree that they have an MO. They are, however, not in business to lose money, and they are beheld to a Board of Director and Shareholders. I can say that I have never directly, or indirectly seen anything related to denying claims to make more money.

Have you read the naviHealth lawsuit?

It's alleged they made a business decision to not deviate from naviHealth's post acute care recommendations by more than 1% because less than 1% of people appealed those decisions (this is in MA, so these are people coming off a hospital stay that are old and may need care at a nursing facility or at home). These are generally expensive claims.

However, those that did appeal, won those appeals around 90% of the time.

MA allows up to 100 days in a nursing home following a three day hospital stay. UHG's model meant patients rarely stayed more than 14 days before the denials came, regardless of what the doctor recommended. It was based on a database of around six million folks.

Now, I will agree with you that UHG is generally aloof. I know of several businesses they purchased and shut down or ignored. Unfortunately, that's not really an excuse.

As for them being beholden to shareholders, I agree that's the core problem with the US insurance industry. There's a reason non-profits generally score higher in MA Star Ratings for example.

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

I assume UHG purchased naviHealth because they thought it would be profitable and/or have strategic value.

Are you telling me they didn't understand why it was profitable?

And when they purchase other companies that have high denial rates (and thus are likely more profitable because they pay out less claims) they don't know that's why they're more profitable?


I know there's a lot more here, but we can't pretend UHG doesn't have an MO even when they acquire companies.

UHG does not always purchase companies based on profitability. A lot of times companies have specific technologies, software, innovations that will benefit UHG. However, I think it is safe to assume that they purchased a theoretical company because it was either currently profitable, or it could be profitable at scale.

I cannot answer why the M&A team purchased a specific company.

I do not agree that they have an MO. They are, however, not in business to lose money, and they are beheld to a Board of Director and Shareholders. I can say that I have never directly, or indirectly seen anything related to denying claims to make more money.

Have you read the naviHealth lawsuit?

It's alleged they made a business decision to not deviate from naviHealth's post acute care recommendations by more than 1% because less than 1% of people appealed those decisions (this is in MA, so these are people coming off a hospital stay that are old and may need care at a nursing facility or at home). These are generally expensive claims.

However, those that did appeal, won those appeals around 90% of the time.

MA allows up to 100 days in a nursing home following a three day hospital stay. UHG's model meant patients rarely stayed more than 14 days before the denials came, regardless of what the doctor recommended. It was based on a database of around six million folks.

Now, I will agree with you that UHG is generally aloof. I know of several businesses they purchased and shut down or ignored. Unfortunately, that's not really an excuse.

As for them being beholden to shareholders, I agree that's the core problem with the US insurance industry. There's a reason non-profits generally score higher in MA Star Ratings for example.

I am familiar with the lawsuit. I cannot speak specifically to anything that is currently being litigated. I hope you understand this. As for the capitalism vs. socialism and state-run health insurance, that is not a topic I want to get into,

Understood. But it doesn't paint a compelling picture that UHG has never denied claims due to profitability concerns.

Even the use of the AI - which is commonplace in claims approvals - is to improve profitability by driving down labor costs.

 

[Sparky Polastri]

Wow. I figured this thread would be locked, deleted, or severely pruned this morning.

"no politics allowed" is rather subjective apparently

 

[Gjallarhorn]

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

I assume UHG purchased naviHealth because they thought it would be profitable and/or have strategic value.

Are you telling me they didn't understand why it was profitable?

And when they purchase other companies that have high denial rates (and thus are likely more profitable because they pay out less claims) they don't know that's why they're more profitable?


I know there's a lot more here, but we can't pretend UHG doesn't have an MO even when they acquire companies.

UHG does not always purchase companies based on profitability. A lot of times companies have specific technologies, software, innovations that will benefit UHG. However, I think it is safe to assume that they purchased a theoretical company because it was either currently profitable, or it could be profitable at scale.

I cannot answer why the M&A team purchased a specific company.

I do not agree that they have an MO. They are, however, not in business to lose money, and they are beheld to a Board of Director and Shareholders. I can say that I have never directly, or indirectly seen anything related to denying claims to make more money.

Have you read the naviHealth lawsuit?

It's alleged they made a business decision to not deviate from naviHealth's post acute care recommendations by more than 1% because less than 1% of people appealed those decisions (this is in MA, so these are people coming off a hospital stay that are old and may need care at a nursing facility or at home). These are generally expensive claims.

However, those that did appeal, won those appeals around 90% of the time.

MA allows up to 100 days in a nursing home following a three day hospital stay. UHG's model meant patients rarely stayed more than 14 days before the denials came, regardless of what the doctor recommended. It was based on a database of around six million folks.

Now, I will agree with you that UHG is generally aloof. I know of several businesses they purchased and shut down or ignored. Unfortunately, that's not really an excuse.

As for them being beholden to shareholders, I agree that's the core problem with the US insurance industry. There's a reason non-profits generally score higher in MA Star Ratings for example.

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

I assume UHG purchased naviHealth because they thought it would be profitable and/or have strategic value.

Are you telling me they didn't understand why it was profitable?

And when they purchase other companies that have high denial rates (and thus are likely more profitable because they pay out less claims) they don't know that's why they're more profitable?


I know there's a lot more here, but we can't pretend UHG doesn't have an MO even when they acquire companies.

UHG does not always purchase companies based on profitability. A lot of times companies have specific technologies, software, innovations that will benefit UHG. However, I think it is safe to assume that they purchased a theoretical company because it was either currently profitable, or it could be profitable at scale.

I cannot answer why the M&A team purchased a specific company.

I do not agree that they have an MO. They are, however, not in business to lose money, and they are beheld to a Board of Director and Shareholders. I can say that I have never directly, or indirectly seen anything related to denying claims to make more money.

Have you read the naviHealth lawsuit?

It's alleged they made a business decision to not deviate from naviHealth's post acute care recommendations by more than 1% because less than 1% of people appealed those decisions (this is in MA, so these are people coming off a hospital stay that are old and may need care at a nursing facility or at home). These are generally expensive claims.

However, those that did appeal, won those appeals around 90% of the time.

MA allows up to 100 days in a nursing home following a three day hospital stay. UHG's model meant patients rarely stayed more than 14 days before the denials came, regardless of what the doctor recommended. It was based on a database of around six million folks.

Now, I will agree with you that UHG is generally aloof. I know of several businesses they purchased and shut down or ignored. Unfortunately, that's not really an excuse.

As for them being beholden to shareholders, I agree that's the core problem with the US insurance industry. There's a reason non-profits generally score higher in MA Star Ratings for example.

I am familiar with the lawsuit. I cannot speak specifically to anything that is currently being litigated. I hope you understand this. As for the capitalism vs. socialism and state-run health insurance, that is not a topic I want to get into,

Understood. But it doesn't paint a compelling picture that UHG has never denied claims due to profitability concerns.

Even the use of the AI - which is commonplace in claims approvals - is to improve profitability by driving down labor costs.

I agree that using AI for pre-approvals and pre-auth is fine, and ethical. I do not think it is ok for denials.

 

[uwillbsoon]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

I assume UHG purchased naviHealth because they thought it would be profitable and/or have strategic value.

Are you telling me they didn't understand why it was profitable?

And when they purchase other companies that have high denial rates (and thus are likely more profitable because they pay out less claims) they don't know that's why they're more profitable?


I know there's a lot more here, but we can't pretend UHG doesn't have an MO even when they acquire companies.

without knowing the specifics here, there are more reasons that companies acquire others that go beyond "profit".

could be they wanted the technology, the intellectual property, the people, the processes. could be to squelch competition. could be to prevent a competitor from purchasing, etc.

Correct. The company offered more value than their AI, no doubt. But they continued using the AI after the purchase. UHG, I mean. I don't get why we should let them off the hook because they acquired a company whose technology they were using and kept using it.

 

[matttyl]

I don’t want to derail the conversation here - I’m glad that he was caught and that he will face justice. But the idea of claim denials from insurance carriers was brought up here a few times (and by the media at large over the past week). If we assume that no claims can be denied, or that no claims are being denied - well that would obviously mean that more claims are being paid (and on average, more expensive claims as those are generally the ones most often denied). If more claim are being paid, then the insurance carriers would need to charge a higher premium to offset them.

AHIP (I know, they have a bias, but follow me here) does an annual (I think) chart of where your premium dollar goes. For every (average) premium dollar an insurance company receives, 24.2 cents goes to Rx (this number has grow crazy fast the last few years), 17.6 cents goes to inpatient hospital care, 19.9 cents to outpatient care, 3.2 cents to ER costs, 11.6 cents to Dr visits, and 7.1 cents to ambulance services and labs and “other”. That’s about 84 cents of each dollar. From there some companies (not all) pay taxes and fees, averaging 3.4 cents. They then pay guys like me (agents/brokers) a piece (not much, let me tell you), and after other overhead and admin costs make, on average, about 2.4 cents in profit (though I’ve seen elsewhere that number being closer to 3.5 cents - regardless, it’s pretty low).

Just because of how it all works, a lower denial rate would lead to higher premiums. But m not attempting to justify all (or really any) denials, but there needs to be some system in place to make sure the care/expense is justified, and honestly to prevent fraud.

 

[Chemical X]

i am no eggspurt, but he was charged with 2nd degree murder and not 1st? this wasn’t premeditated?

 

[Gjallarhorn]

i am no eggspurt, but he was charged with 2nd degree murder and not 1st? this wasn’t premeditated?

New York is very weird with their requirements for 1st degree

 

[El Floppo]

i am no eggspurt, but he was charged with 2nd degree murder and not 1st? this wasn’t premeditated?

Wow... Really?