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

[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.

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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

 

[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.

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.

I didn't think anyone is saying that there should be no denials.

But the industry does have a history of questionable denial tactics.

 

[IvanKaramazov]

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.

That's the problem with this sort of argument. If I wave my hands and refer to broad social trends, people will tell me that I'm imagining things. If I point to actual examples of the thing I'm talking about, like two well-known posters talking about killing their rivals and a mod deciding that that was inside the Overton window for this PG forum, I'm accused of cherry picking. I know there is no amount or type of evidence that I can present to convince you that 2024 is similar to 1972. I'm kind of just stating it for the record.

(Also, I am extremely familiar with our country's history with left-wing domestic terrorism. My views about our current moment are heavily influenced by that historical knowledge.)

 

[Joe Bryant]

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

"no politics allowed" is rather subjective apparently

Yes. I acknowledged that above.

It might be best if we shut down the thread but I thought it was a good discussion.

 

[matttyl]

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.

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.

I didn't think anyone is saying that there should be no denials.

But the industry does have a history of questionable denial tactics.

And they should be called out when they aren’t warranted.

 

[BlackCrowes]

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

thought it was just killing a witness, killing a cop, or torture killings. that could be me just channeling my Law & Order reruns

 

[El Floppo]

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

"no politics allowed" is rather subjective apparently

Yes. I acknowledged that above.

It might be best if we shut down the thread but I thought it was a good discussion.

It's been a very good discussion... I genuinely hope you don't shut it down.

 

[Mister CIA]

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.

Off-topic: I think Yelp was essentially replace by Google reviews (found within Google Maps). I know I use it to sometime check out new places.

 

[Joe Bryant]

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.

That's the problem with this sort of argument. If I wave my hands and refer to broad social trends, people will tell me that I'm imagining things. If I point to actual examples of the thing I'm talking about, like two well-known posters talking about killing their rivals and a mod deciding that that was inside the Overton window for this PG forum, I'm accused of cherry picking. I know there is no amount or type of evidence that I can present to convince you that 2024 is similar to 1972. I'm kind of just stating it for the record.

(Also, I am extremely familiar with our country's history with left-wing domestic terrorism. My views about our current moment are heavily influenced by that historical knowledge.)

Yes. I was pretty surprised the poster who I felt like I knew well and was not a crazy person said he loved the guillotine protest in front of Bezos house.

Now granted, I don't think that poster would actually murder someone. But the fact he thought the guillotine there was great was surprising to me. I'd like to brush things like that off as extremist fringe. But not always sure that's the reality.

 

[Gjallarhorn]

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

"no politics allowed" is rather subjective apparently

Yes. I acknowledged that above.

It might be best if we shut down the thread but I thought it was a good discussion.

It's been a very good discussion... I genuinely hope you don't shut it down.

I agree, this has been very therapeutic. I almost deleted this account/site entirely today, then stumbled onto this section of the site when looking into how to delete my account. If anything, you guys have helped restore my faith in complete strangers on the internet.

 

[El Floppo]

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

"no politics allowed" is rather subjective apparently

Yes. I acknowledged that above.

It might be best if we shut down the thread but I thought it was a good discussion.

It's been a very good discussion... I genuinely hope you don't shut it down.

I agree, this has been very therapeutic. I almost deleted this account/site entirely today, then stumbled onto this section of the site when looking into how to delete my account. If anything, you guys have helped restore my faith in complete strangers on the internet.

Sounds like somebody's spent too much time in the shark pool

 

[The Gator]

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

"no politics allowed" is rather subjective apparently

Yes. I acknowledged that above.

It might be best if we shut down the thread but I thought it was a good discussion.

It's been a very good discussion... I genuinely hope you don't shut it down.

I agree, this has been very therapeutic. I almost deleted this account/site entirely today, then stumbled onto this section of the site when looking into how to delete my account. If anything, you guys have helped restore my faith in complete strangers on the internet.

Sounds like somebody's spent too much time in the shark pool

 

[Scoresman]

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.

That's the problem with this sort of argument. If I wave my hands and refer to broad social trends, people will tell me that I'm imagining things. If I point to actual examples of the thing I'm talking about, like two well-known posters talking about killing their rivals and a mod deciding that that was inside the Overton window for this PG forum, I'm accused of cherry picking. I know there is no amount or type of evidence that I can present to convince you that 2024 is similar to 1972. I'm kind of just stating it for the record.

(Also, I am extremely familiar with our country's history with left-wing domestic terrorism. My views about our current moment are heavily influenced by that historical knowledge.)

Yes. I was pretty surprised the poster who I felt like I knew well and was not a crazy person said he loved the guillotine protest in front of Bezos house.

Now granted, I don't think that poster would actually murder someone. But the fact he thought the guillotine there was great was surprising to me. I'd like to brush things like that off as extremist fringe. But not always sure that's the reality.

As others have said, I dont think it is as small a percentage as you think, especially in this case with people celebrating the murder. For this one you have all of the usual fringe anti-CEO, anti-billionaires coming out, but you also have all of the people who think murder is justified because his company was responsible for X number of denial that led to X number of deaths.

I've also seen the phrase "I'm not celebrating his murder, but I'm not mourning over his obituary" or similar posted a lot in the last week. Not sure how I follow that logic.

 

[Sparky Polastri]

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

"no politics allowed" is rather subjective apparently

Yes. I acknowledged that above.

It might be best if we shut down the thread but I thought it was a good discussion.

For the record, I don't think there's a problem with the discussion. Can't really wonder why people struggle with the rules though.

 

[belljr]

Murdering MLK was left wing violence?

Now I've heard everything

 

[rockaction]

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

N.Y. Penal Law § 125.27 – Murder in the first degree

A person is guilty of murder in the first degree when, 1. With intent to cause the death of another person, he…

newyork.public.law

I remember it being very tricky. I took the NY bar and passed it. I do not remember the first-degree/second-degree distinction because this was 2010. That was about fifteen years ago. But here is the statute. We did not study statutes, but used BarBri, which is a test prep that most students use in bar preparation.

 

[Joe Bryant]

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.

That's the problem with this sort of argument. If I wave my hands and refer to broad social trends, people will tell me that I'm imagining things. If I point to actual examples of the thing I'm talking about, like two well-known posters talking about killing their rivals and a mod deciding that that was inside the Overton window for this PG forum, I'm accused of cherry picking. I know there is no amount or type of evidence that I can present to convince you that 2024 is similar to 1972. I'm kind of just stating it for the record.

(Also, I am extremely familiar with our country's history with left-wing domestic terrorism. My views about our current moment are heavily influenced by that historical knowledge.)

Yes. I was pretty surprised the poster who I felt like I knew well and was not a crazy person said he loved the guillotine protest in front of Bezos house.

Now granted, I don't think that poster would actually murder someone. But the fact he thought the guillotine there was great was surprising to me. I'd like to brush things like that off as extremist fringe. But not always sure that's the reality.

As others have said, I dont think it is as small a percentage as you think, especially in this case with people celebrating the murder. For this one you have all of the usual fringe anti-CEO, anti-billionaires coming out, but you also have all of the people who think murder is justified because his company was responsible for X number of denial that led to X number of deaths.

I've also seen the phrase "I'm not celebrating his murder, but I'm not mourning over his obituary" or similar posted a lot in the last week. Not sure how I follow that logic.

Agreed. I see a good bit of that, too.

I'd like to think it's super fringe extremists. My eyes have me questioning if that's necessarily the case.

 

[Joe Bryant]

If anything, you guys have helped restore my faith in complete strangers on the internet.

Thank you.

But don't sign up to be a forum moderator if you want to keep that faith...

On a serious note, I think this is a good example of what I said above. I know the jokes regardless of the topic are fun for some. But I think there's value in being civil as I think that can bring out good discussion.

 

[Dr. Octopus]

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.

That's the problem with this sort of argument. If I wave my hands and refer to broad social trends, people will tell me that I'm imagining things. If I point to actual examples of the thing I'm talking about, like two well-known posters talking about killing their rivals and a mod deciding that that was inside the Overton window for this PG forum, I'm accused of cherry picking. I know there is no amount or type of evidence that I can present to convince you that 2024 is similar to 1972. I'm kind of just stating it for the record.

(Also, I am extremely familiar with our country's history with left-wing domestic terrorism. My views about our current moment are heavily influenced by that historical knowledge.)

Yes. I was pretty surprised the poster who I felt like I knew well and was not a crazy person said he loved the guillotine protest in front of Bezos house.

Now granted, I don't think that poster would actually murder someone. But the fact he thought the guillotine there was great was surprising to me. I'd like to brush things like that off as extremist fringe. But not always sure that's the reality.

As others have said, I dont think it is as small a percentage as you think, especially in this case with people celebrating the murder. For this one you have all of the usual fringe anti-CEO, anti-billionaires coming out, but you also have all of the people who think murder is justified because his company was responsible for X number of denial that led to X number of deaths.

I've also seen the phrase "I'm not celebrating his murder, but I'm not mourning over his obituary" or similar posted a lot in the last week. Not sure how I follow that logic.

Agreed. I see a good bit of that, too.

I'd like to think it's super fringe extremists. My eyes have me questioning if that's necessarily the case.

What percentage of the population would need to be making these claims where it wouldn’t be considered a “fringe” opinion?

1%?
3%?
25%?

Are you seeing it in “real life” or social media?

 

[Chemical X]

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

you are correct…..not so much weird, but very specific. i read the statute quickly just now.

 

[Max Power]

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.

That's the problem with this sort of argument. If I wave my hands and refer to broad social trends, people will tell me that I'm imagining things. If I point to actual examples of the thing I'm talking about, like two well-known posters talking about killing their rivals and a mod deciding that that was inside the Overton window for this PG forum, I'm accused of cherry picking. I know there is no amount or type of evidence that I can present to convince you that 2024 is similar to 1972. I'm kind of just stating it for the record.

(Also, I am extremely familiar with our country's history with left-wing domestic terrorism. My views about our current moment are heavily influenced by that historical knowledge.)

Yes. I was pretty surprised the poster who I felt like I knew well and was not a crazy person said he loved the guillotine protest in front of Bezos house.

Now granted, I don't think that poster would actually murder someone. But the fact he thought the guillotine there was great was surprising to me. I'd like to brush things like that off as extremist fringe. But not always sure that's the reality.

As others have said, I dont think it is as small a percentage as you think, especially in this case with people celebrating the murder. For this one you have all of the usual fringe anti-CEO, anti-billionaires coming out, but you also have all of the people who think murder is justified because his company was responsible for X number of denial that led to X number of deaths.

I've also seen the phrase "I'm not celebrating his murder, but I'm not mourning over his obituary" or similar posted a lot in the last week. Not sure how I follow that logic.

Pretty sure I know what people are trying to say with the bolded. I'm more in the camp of numb to it. We average 20,000 murders a year in this country. I'm guessing it's mostly the sensational aspect of the murder that captured everyone's attention, but it's also clear his money and prestige elevated the coverage.

 

[Joe Bryant]

Are you seeing it in “real life” or social media?

People I know in real life posting on social media.

And for sure, it's not an outright threat. People are smart enough not to do that.

It's the winking at violence.

The "They asked me if I would help find the CEO shooter. My health care doesn't cover vision so I didn't see ####"

They're smart enough not to post something that will actually cost them. But the winking is notable in my opinion.

 

[Dr. Octopus]

Are you seeing it in “real life” or social media?

People I know in real life posting on social media.

And for sure, it's not an outright threat. People are smart enough not to do that.

It's the winking at violence.

The "They asked me if I would help find the CEO shooter. My health care doesn't cover vision so I didn't see ####"

They're smart enough not to post something that will actually cost them. But the winking is notable in my opinion.

I was about to respond that you didn’t really answer my question - but then you edited it to crop out the real question I was interested in.

You seem convinced this isn’t a fringe position. What % of people do you think are “winking” or flat out saying “Thompson deserved it”? How many would it need to be where it’s not a fringe position?

 

[Scoresman]

Are you seeing it in “real life” or social media?

People I know in real life posting on social media.

And for sure, it's not an outright threat. People are smart enough not to do that.

It's the winking at violence.

The "They asked me if I would help find the CEO shooter. My health care doesn't cover vision so I didn't see ####"

They're smart enough not to post something that will actually cost them. But the winking is notable in my opinion.

Then you go to anonymous message boards that are not moderated as well as this one and see how people truly feel.

 

[Joe Bryant]

Are you seeing it in “real life” or social media?

People I know in real life posting on social media.

And for sure, it's not an outright threat. People are smart enough not to do that.

It's the winking at violence.

The "They asked me if I would help find the CEO shooter. My health care doesn't cover vision so I didn't see ####"

They're smart enough not to post something that will actually cost them. But the winking is notable in my opinion.

I was about to respond that you didn’t really answer my question - but then you edited it to crop out the real question I was interested in.

You seem convinced this isn’t a fringe position. What % of people do you think are “winking” or flat out saying “Thompson deserved it”? How many would it need to be where it’s not a fringe position?

I answered the question I had an answer to.

For the other question of how many people it would need to be, I don't really know.

And I'm not sure how you've arrived at "You seem convinced this isn’t a fringe position."

I've said repeatedly things like "I'd like to think it's super fringe extremists. My eyes have me questioning if that's necessarily the case." If you think that means I'm convinced, I don't know what to tell you.

 

[Joe Bryant]

Are you seeing it in “real life” or social media?

People I know in real life posting on social media.

And for sure, it's not an outright threat. People are smart enough not to do that.

It's the winking at violence.

The "They asked me if I would help find the CEO shooter. My health care doesn't cover vision so I didn't see ####"

They're smart enough not to post something that will actually cost them. But the winking is notable in my opinion.

Then you go to anonymous message boards that are not moderated as well as this one and see how people truly feel.

Understood. That's always a weird thing about anonymity, right? In some ways, it makes people say things they might not normally say as they're emboldened by the lack of consequences. Sometimes that's a positive as someone might share something important and personal they wouldn't normally. Or maybe they act tougher than they really feel. Or maybe they are able to be honest. It's a range.

 

[Brunell4MVP]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

 

[Dr. Octopus]

Are you seeing it in “real life” or social media?

People I know in real life posting on social media.

And for sure, it's not an outright threat. People are smart enough not to do that.

It's the winking at violence.

The "They asked me if I would help find the CEO shooter. My health care doesn't cover vision so I didn't see ####"

They're smart enough not to post something that will actually cost them. But the winking is notable in my opinion.

I was about to respond that you didn’t really answer my question - but then you edited it to crop out the real question I was interested in.

You seem convinced this isn’t a fringe position. What % of people do you think are “winking” or flat out saying “Thompson deserved it”? How many would it need to be where it’s not a fringe position?

I answered the question I had an answer to.

For the other question of how many people it would need to be, I don't really know.

And I'm not sure how you've arrived at "You seem convinced this isn’t a fringe position." I've said repeatedly things like "I'd like to think it's super fringe extremists. My eyes have me questioning if that's necessarily the case." If you think that means I'm convinced, I don't know what to tell you.

I arrived on it based on your posts so far?

If it mischaracterizes your position, I’m sorry - but that’s my perception of your posts.

 

[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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

So you're saying their use of the AI was complex?

Or the purchase of naviHealth? If naviHealth, sure. i agree. Certainly didn't buy it only for the AI.

All I'm saying is in this specific class action suit if what the plaintiffs state as fact is true, UHG used AI to deny claims and improve profitability.

Someone else had tried to say that UHG buys companies all the time and that may lead to high denial rates.

In MA post acute care claims, UHC's denial rate went up from 10 to 22% post the naviHealth purchase. It's a small sample, but I don't understand how you can blame naviHealth when UHG (or in this case, possibly Optum) likely bought the company in part for the technology and then UHC continued to use the technology.

Using the AI was a conscious choice by UHC. To blame an acquisition seems factually inaccurate in this case. In other cases, I don't know. I haven't read all the lawsuits. Just familiar with this one.

 

[rockaction]

I arrived on it based on your posts so far?

If it mischaracterizes your position, I’m sorry - but that’s my perception of your posts.

I’m getting something totally different from his posts. It sounds like he can’t believe it, but it’s what he’s seeing and in such numbers that maybe he needs to reconsider that it isn’t a fringe position. It sounded to me like he’s fairly open to arguments both pro and con. Just my two cents again.

 

[Chemical X]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

i’m in italy and if you are registered with the SSN (public health system), there is no insurance and no denial of service. it is national based, administered regionally, so quality may vary. many from the south come north. it is quasi HMO in that you pick or are assigned a PCP who provides referrals. the only time a charge exists is a cost sharing for some specialists, meds and diagnostics. i am not in the system yet and have private insurance. they don’t know how it works here and i am rarely charged for visits somehow. i did need an MRI and they charged me €75.

 

[Joe Bryant]

Are you seeing it in “real life” or social media?

People I know in real life posting on social media.

And for sure, it's not an outright threat. People are smart enough not to do that.

It's the winking at violence.

The "They asked me if I would help find the CEO shooter. My health care doesn't cover vision so I didn't see ####"

They're smart enough not to post something that will actually cost them. But the winking is notable in my opinion.

I was about to respond that you didn’t really answer my question - but then you edited it to crop out the real question I was interested in.

You seem convinced this isn’t a fringe position. What % of people do you think are “winking” or flat out saying “Thompson deserved it”? How many would it need to be where it’s not a fringe position?

I answered the question I had an answer to.

For the other question of how many people it would need to be, I don't really know.

And I'm not sure how you've arrived at "You seem convinced this isn’t a fringe position." I've said repeatedly things like "I'd like to think it's super fringe extremists. My eyes have me questioning if that's necessarily the case." If you think that means I'm convinced, I don't know what to tell you.

I arrived on it based on your posts so far?

If it mischaracterizes your position, I’m sorry - but that’s my perception of your posts.

Thanks GB. No worries. Apology accepted.

I think it's best to believe the words people write. I've written repeatedly things like "I'd like to think it's super fringe extremists. My eyes have me questioning if that's necessarily the case."

The perception that "I'm convinced" is not correct.

I meant what I wrote in my eyes have me questioning how super fringe extremist the posts are.

 

[El Floppo]

Are you seeing it in “real life” or social media?

People I know in real life posting on social media.

And for sure, it's not an outright threat. People are smart enough not to do that.

It's the winking at violence.

The "They asked me if I would help find the CEO shooter. My health care doesn't cover vision so I didn't see ####"

They're smart enough not to post something that will actually cost them. But the winking is notable in my opinion.

I was about to respond that you didn’t really answer my question - but then you edited it to crop out the real question I was interested in.

You seem convinced this isn’t a fringe position. What % of people do you think are “winking” or flat out saying “Thompson deserved it”? How many would it need to be where it’s not a fringe position?

I answered the question I had an answer to.

For the other question of how many people it would need to be, I don't really know.

And I'm not sure how you've arrived at "You seem convinced this isn’t a fringe position." I've said repeatedly things like "I'd like to think it's super fringe extremists. My eyes have me questioning if that's necessarily the case." If you think that means I'm convinced, I don't know what to tell you.

I arrived on it based on your posts so far?

If it mischaracterizes your position, I’m sorry - but that’s my perception of your posts.

Thanks GB. No worries. Apology accepted.

I think it's best to believe the words people write. I've written repeatedly things like "I'd like to think it's super fringe extremists. My eyes have me questioning if that's necessarily the case."

The perception that "I'm convinced" is not correct.

I meant what I wrote in my eyes have me questioning how super fringe extremist the posts are.

Your mind plays tricks on you...you play tricks back. /Peewee

 

[Joe Bryant]

Are you seeing it in “real life” or social media?

People I know in real life posting on social media.

And for sure, it's not an outright threat. People are smart enough not to do that.

It's the winking at violence.

The "They asked me if I would help find the CEO shooter. My health care doesn't cover vision so I didn't see ####"

They're smart enough not to post something that will actually cost them. But the winking is notable in my opinion.

I was about to respond that you didn’t really answer my question - but then you edited it to crop out the real question I was interested in.

You seem convinced this isn’t a fringe position. What % of people do you think are “winking” or flat out saying “Thompson deserved it”? How many would it need to be where it’s not a fringe position?

I answered the question I had an answer to.

For the other question of how many people it would need to be, I don't really know.

And I'm not sure how you've arrived at "You seem convinced this isn’t a fringe position." I've said repeatedly things like "I'd like to think it's super fringe extremists. My eyes have me questioning if that's necessarily the case." If you think that means I'm convinced, I don't know what to tell you.

I arrived on it based on your posts so far?

If it mischaracterizes your position, I’m sorry - but that’s my perception of your posts.

Thanks GB. No worries. Apology accepted.

I think it's best to believe the words people write. I've written repeatedly things like "I'd like to think it's super fringe extremists. My eyes have me questioning if that's necessarily the case."

The perception that "I'm convinced" is not correct.

I meant what I wrote in my eyes have me questioning how super fringe extremist the posts are.

Your mind plays tricks on you...you play tricks back. /Peewee

Sometimes.

 

[matttyl]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

 

[beer 30]

then stumbled onto this section of the site when looking into how to delete my account

That tracks, exactly where the FFA should be.

 

[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.

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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

So you're saying their use of the AI was complex?

Or the purchase of naviHealth? If naviHealth, sure. i agree. Certainly didn't buy it only for the AI.

All I'm saying is in this specific class action suit if what the plaintiffs state as fact is true, UHG used AI to deny claims and improve profitability.

Someone else had tried to say that UHG buys companies all the time and that may lead to high denial rates.

In MA post acute care claims, UHC's denial rate went up from 10 to 22% post the naviHealth purchase. It's a small sample, but I don't understand how you can blame naviHealth when UHG (or in this case, possibly Optum) likely bought the company in part for the technology and then UHC continued to use the technology.

Using the AI was a conscious choice by UHC. To blame an acquisition seems factually inaccurate in this case. In other cases, I don't know. I haven't read all the lawsuits. Just familiar with this one.

there's more to this scenario than United Health bought X company to acquire their AI in order to deny.... whatever the current belief is... 98.8% of claims.

and there's likely a lot more to learn about how claims are/are not denied than the internet collective suddenly rising up in the last 3 days to claim that insurance companies are using AI to blanket deny claims every 1.2 seconds or whatever.

 

[Cowboysfan8]

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

"no politics allowed" is rather subjective apparently

Yes. I acknowledged that above.

It might be best if we shut down the thread but I thought it was a good discussion.

It's been a very good discussion... I genuinely hope you don't shut it down.

I agree, this has been very therapeutic. I almost deleted this account/site entirely today, then stumbled onto this section of the site when looking into how to delete my account. If anything, you guys have helped restore my faith in complete strangers on the internet.

Sounds like somebody's spent too much time in the shark pool

You spelled Eagles thread wrong

 

[Cowboysfan8]

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

"no politics allowed" is rather subjective apparently

Yes. I acknowledged that above.

It might be best if we shut down the thread but I thought it was a good discussion.

It's been a very good discussion... I genuinely hope you don't shut it down.

Agreed, this thread has been a great read imo

 

[Terminalxylem]

I expect many people are waiting to hear his story, some beloved aunt or friend being wrongfully denied a necessary healthcare procedure leading to a slow and painful death laid at the feet of the insurer. What if no such story exists and this guy just views himself as the radical savior of society based on things he believes happened to others? His writings reportedly indicate he believes violence is the only answer and is the necessary path he had to take.

But by all accounts, that wasn't his visible mindset before he went radio silent on social media in the last few months. Something shifted massively in his thinking towards that direction.

As you say- was it somebody close to him that suffered with insurance (likely not immediate family given their comparative wealth).. maybe related to his own back or autoimmune issues?

The reports from friends are complete shock at these actions, including that "manifesto". What was the catalyst?

As I said upthread, he’s the right age for a psychotic break, either from schizophrenia or bipolar disorder. He’s also the right age to get heavily involved with mind-altering substances, and the (sometimes) criminals who distribute them.

Agree with whomever said gen Z seems a little more upset at the corporate world, and the internet provides ample fuel for the fire of radical thoughts/actions.

To what “autoimmune issues” do you refer? Chronic Lyme?

 

[rockaction]

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

"no politics allowed" is rather subjective apparently

Yes. I acknowledged that above.

It might be best if we shut down the thread but I thought it was a good discussion.

It's been a very good discussion... I genuinely hope you don't shut it down.

I agree, this has been very therapeutic. I almost deleted this account/site entirely today, then stumbled onto this section of the site when looking into how to delete my account. If anything, you guys have helped restore my faith in complete strangers on the internet.

Sounds like somebody's spent too much time in the shark pool

You spelled Eagles thread wrong

Wait, is this serious? Did he wind up pissed because of Eagles fans? I can totally see that happening. abrunn1133, why were you leaving us?

 

[mr. furley]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

my anecdotal evidence here, having family living in Europe, medical bills are EXTREMELY low. like, surgery there costs less than for me to go for a regular office checkup.

 

[RCon]

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

Accurate? Not?

This bit in particular stuck out to me:

“Say there is a contract between an insurance company like Anthem and an anesthesiologist,” Garmon told Vox. “What is always in that contract is a clause that says, ‘You, the provider, agree to accept the reimbursement rules in this contract as payment in full.’ That means the provider cannot then turn around and ask [the patient] for money.”

Seems like my providers do exactly that all the time. That is, my bills often look like this:
Original Charge: $500
Insurance Paid: $300
Remainder Owed: $200

Do all provider/insurance agreements have a "payment in full" clause as described above?

 

[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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

So you're saying their use of the AI was complex?

Or the purchase of naviHealth? If naviHealth, sure. i agree. Certainly didn't buy it only for the AI.

All I'm saying is in this specific class action suit if what the plaintiffs state as fact is true, UHG used AI to deny claims and improve profitability.

Someone else had tried to say that UHG buys companies all the time and that may lead to high denial rates.

In MA post acute care claims, UHC's denial rate went up from 10 to 22% post the naviHealth purchase. It's a small sample, but I don't understand how you can blame naviHealth when UHG (or in this case, possibly Optum) likely bought the company in part for the technology and then UHC continued to use the technology.

Using the AI was a conscious choice by UHC. To blame an acquisition seems factually inaccurate in this case. In other cases, I don't know. I haven't read all the lawsuits. Just familiar with this one.

there's more to this scenario than United Health bought X company to acquire their AI in order to deny.... whatever the current belief is... 98.8% of claims.

and there's likely a lot more to learn about how claims are/are not denied than the internet collective suddenly rising up in the last 3 days to claim that insurance companies are using AI to blanket deny claims every 1.2 seconds or whatever.

Yes, you are correct.

Which is why I brought up a specific lawsuit with specific facts about denials and appeals.

 

[Willie Neslon]

I think there's a chance his lawyers will go with an insanity defense. He reportedly lost touch with his friends and family, underwent a major back surgery, and moved to Hawaii unannounced. His outburst while getting out of the car today suggests that his disillusionment may have given way to psychosis. It’s a tough defense to win but it seems his family has resources.

 

[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.

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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

So you're saying their use of the AI was complex?

Or the purchase of naviHealth? If naviHealth, sure. i agree. Certainly didn't buy it only for the AI.

All I'm saying is in this specific class action suit if what the plaintiffs state as fact is true, UHG used AI to deny claims and improve profitability.

Someone else had tried to say that UHG buys companies all the time and that may lead to high denial rates.

In MA post acute care claims, UHC's denial rate went up from 10 to 22% post the naviHealth purchase. It's a small sample, but I don't understand how you can blame naviHealth when UHG (or in this case, possibly Optum) likely bought the company in part for the technology and then UHC continued to use the technology.

Using the AI was a conscious choice by UHC. To blame an acquisition seems factually inaccurate in this case. In other cases, I don't know. I haven't read all the lawsuits. Just familiar with this one.

there's more to this scenario than United Health bought X company to acquire their AI in order to deny.... whatever the current belief is... 98.8% of claims.

and there's likely a lot more to learn about how claims are/are not denied than the internet collective suddenly rising up in the last 3 days to claim that insurance companies are using AI to blanket deny claims every 1.2 seconds or whatever.

Yes, you are correct.

Which is why I brought up a specific lawsuit with specific facts about denials and appeals.

imo, you are conflating many different pieces of information that aren't necessarily related to come to a conclusion.

i'm no expert but i see a lot of people on the internet, and in this thread, speaking confidently about complexities they just learned the very basics of 3-4 days ago.

 

[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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

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.

likely because it's an incredibly complex situation and not black/white like the internet wants it to be

So you're saying their use of the AI was complex?

Or the purchase of naviHealth? If naviHealth, sure. i agree. Certainly didn't buy it only for the AI.

All I'm saying is in this specific class action suit if what the plaintiffs state as fact is true, UHG used AI to deny claims and improve profitability.

Someone else had tried to say that UHG buys companies all the time and that may lead to high denial rates.

In MA post acute care claims, UHC's denial rate went up from 10 to 22% post the naviHealth purchase. It's a small sample, but I don't understand how you can blame naviHealth when UHG (or in this case, possibly Optum) likely bought the company in part for the technology and then UHC continued to use the technology.

Using the AI was a conscious choice by UHC. To blame an acquisition seems factually inaccurate in this case. In other cases, I don't know. I haven't read all the lawsuits. Just familiar with this one.

there's more to this scenario than United Health bought X company to acquire their AI in order to deny.... whatever the current belief is... 98.8% of claims.

and there's likely a lot more to learn about how claims are/are not denied than the internet collective suddenly rising up in the last 3 days to claim that insurance companies are using AI to blanket deny claims every 1.2 seconds or whatever.

Yes, you are correct.

Which is why I brought up a specific lawsuit with specific facts about denials and appeals.

imo, you are conflating many different pieces of information that aren't necessarily related to come to a conclusion.

i'm no expert but i see a lot of people on the internet, and in this thread, speaking confidently about complexities they just learned the very basics of 3-4 days ago.

You may be right.

We can speak to specifics. My conclusion, based on the lawsuit, is that UHC used AI to improve profitability and that AI incorrectly (90% of appealed claims were overturned) denied care to elderly members who had recently been hospitalized.

If the facts in that case change, I'll change my stance.

I'm tangential to the industry. Anecdotally, I know those in the industry that have expressed disdain for UHC, some of whom worked there. Perhaps that's clouding my judgement.

 

[matttyl]

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

Accurate? Not?

This bit in particular stuck out to me:

“Say there is a contract between an insurance company like Anthem and an anesthesiologist,” Garmon told Vox. “What is always in that contract is a clause that says, ‘You, the provider, agree to accept the reimbursement rules in this contract as payment in full.’ That means the provider cannot then turn around and ask [the patient] for money.”

Seems like my providers do exactly that all the time. That is, my bills often look like this:
Original Charge: $500
Insurance Paid: $300
Remainder Owed: $200

Do all provider/insurance agreements have a "payment in full" clause as described above?

Sorta - if the doctor (in your example anesthesiologist) agrees to be “in network” with BCBS, then they accept the pre negotiated rate for service and can’t “balance bill” the individual.

So they bill insurance $1,000.
Insurance says “but the in network rate is $600. You have to write off the other $400 and can’t go after the individual for it.”
Insurance then picks up the $600 in accordance to the policy. Meaning if you haven’t hit your deductible, you might be on the hook for it. If you have hit your deductible/ out of pocket then insurance will pay it.

That’s the way insurance is suppose to work and the agreement between the carrier and provider. That’s the “value” of the insurance.

 

[uwillbsoon]

UHC has a long history of fraudulent activities. I'm old enough to remember their backdating of stock options for Bill McGuire scandal.

That is also probably clouding my judgement.

 

[Gjallarhorn]

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

"no politics allowed" is rather subjective apparently

Yes. I acknowledged that above.

It might be best if we shut down the thread but I thought it was a good discussion.

It's been a very good discussion... I genuinely hope you don't shut it down.

I agree, this has been very therapeutic. I almost deleted this account/site entirely today, then stumbled onto this section of the site when looking into how to delete my account. If anything, you guys have helped restore my faith in complete strangers on the internet.

Sounds like somebody's spent too much time in the shark pool

You spelled Eagles thread wrong

Wait, is this serious? Did he wind up pissed because of Eagles fans? I can totally see that happening. abrunn1133, why were you leaving us?

There is a small subset of people that were getting the better of me on here. It got to the point where it was not worth it anymore. More of a my problem (letting abhorrent people impact me) than a them problem. I just need to do a better job of steering clear of a certain group on here. I own the problem and the solution.