from Hacker News

UnitedHealth Is Sick of Everyone Complaining About Its Claim Denials

by frenchtoast8 on 2/9/25, 5:43 PM with 194 comments

  • by inamberclad on 2/9/25, 6:21 PM

    Seeing my health insurance deny hospital claims that were pre-authorized has been insane. The hospital checked in advance with my insurance that several operations would be covered and the insurance approved. Now that the bill comes, the insurance company has repeatedly denied and denied their claims. Health insurance companies are horrible and parasitic to everyone involved.

  • by kelnos on 2/9/25, 6:19 PM

    Private insurance in the US needs to be completely dismantled, and we need to go to a single payer system. Not a panacea, of course, but what we have is so broken and irredeemable, it's the worst of all worlds. The US has best-in-class (if crazy expensive) health care despite our insurance system, not because of it.

  • by sheldoni on 2/9/25, 6:29 PM

    One of the most interesting things about this whole situation is that nobody is trying to even pretend that the current system is fair or effective. The tone in media and from corporate PR, business leaders, and politicians is either silence or some version of "hey stop talking about that / well it's not MY fault." Everyone knows the system is unfair, parasitic, and literally murderous, but no one in power is willing to take responsibility of any kind or show real leadership in bringing change.

  • by fader on 2/9/25, 6:22 PM

    It's not just denials. This is anecdotal but my company moved from Aetna to UHC starting in January, and there are already dozens of threads in our internal slack about drug co-pays jumping 10-100x, despite the UHC rep's assurances that the plans were equivalent with what we had before.

  • by frenchtoast8 on 2/9/25, 6:22 PM

    Suing (or threatening to sue) everyone and anything that speaks poorly about the company is an interesting PR response, isn't it? I'm used to companies just ignoring the issue and hoping it goes away.

  • by gcapu on 2/9/25, 7:32 PM

    I had a baby. Months later, UH retroactively denied all birth and baby care claims. They claimed I had other insurance, which I don’t. Now I get to prove a negative. So fun.

  • by superkuh on 2/9/25, 6:22 PM

    Maybe there should be a government mediated system for "DMCA", denied medical claim arguements, where anyone could send in a DMCA against a health insurance company and automatically involve the formal legal court system at no cost to themselves. Normally I would not want to involve government but in situations relating to life and death I think it is justified (like other things govs regulate involving life/death).

  • by burnte on 2/9/25, 6:39 PM

    As someone who works in healthcare IT, I can ensure you that everyone is sick of United Healthcare, too. Such a PITA to deal with.

  • by jimt1234 on 2/9/25, 7:12 PM

    It's bad when shareholders are begging the company not to be so evil.

  • by nine_zeros on 2/9/25, 6:19 PM

    There is an easy fix - just don't issue so many denials. Or refund people's premiums.

    Things become very easy when you are willing to sacrifice exec pay and investor returns - at least temporarily.

  • by andrewfromx on 2/9/25, 6:18 PM

    They are just the biggest. Cigna does the same type of denials but is way smaller.

  • by fungiblecog on 2/9/25, 6:27 PM

    This is what you get when profit is prioritised over every other factor. i'm not sure why anyone finds this surprising. Social democrats recognise the role of government is to put in place regulations that temper this kind of behaviour. under Trumps 'slash and burn' approach to regulation expect things to get worse on every field

  • by mitchbob on 2/9/25, 7:16 PM

  • by tekno45 on 2/9/25, 6:26 PM

    If stuff like voluntary plastic surgery wasn't covered, what the hell kind of medical fraud would there be?

    We have OTHER systems to find doctors prescribing drugs, so wtf does insurance provide the consumer except a pathway to debt?

  • by ipython on 2/9/25, 6:39 PM

    This is what’s frustrating with the current political situation. Since we are already wielding the sledgehammer, why not take it to this system, which would actually solve some real problems for every day people?

  • by hingusdingus on 2/9/25, 6:42 PM

    Tempted to complain twice as hard now that I know it gets to them.

  • by underseacables on 2/10/25, 1:11 AM

    And they wonder why so many people are supporting Luigi. I could never condone murder, but I understand and deeply sympathetic. United is the comcast of health insurance

  • by loganc2342 on 2/9/25, 6:41 PM

    > The company, meanwhile, has argued that “Dr. Potter’s claims that she was called out of surgery are false.”

    Were they there?

  • by weare138 on 2/9/25, 6:40 PM

    I mean we're going to keep doing it but we're tired of hearing about it.

  • by AdeptusAquinas on 2/9/25, 6:57 PM

    It recently occurred to me that the crazy expense of the US Healthcare system (most expensive in the world, while also being terrible quality) might be by design: it keeps you desperately tied to your jobs. Just another threat enforcing that weird modern serfdom the Americans are so fond of, along with their unsolved homelessness and massive prison industry.

  • by antisthenes on 2/9/25, 7:08 PM

    Wouldn't it be nice if we could just keep collecting premiums and get paid salaries for doing nothing productive for society?

    Honestly, it's like that Bilbo meme where he's thinking about keeping the Ring.

    I'm sure every neoliberal capitalist dreams of just entrenching themselves in some kind of regulatory-protected business model paradise, so that they can keep "running the business" for hundreds of years, but that's not a good thing to aspire to if you have even a shred of human decency or ethics.

  • by istjohn on 2/9/25, 11:36 PM

    It's clear that health insurance companies are awful, but I wish people weren't so quick to let medical providers off the hook. It takes two to tango, and health insurance companies have found medical providers are eager to protect the status quo.

    Under our system, companies are highly incentivized to spend lavishly on employee health insurance plans since those dollars are not counted as taxable income on the employee's tax returns. By law, at least 80% of those tax advantaged insurance premiums must be passed on to medical providers [0].

    Healthcare providers further benefit from having insurance companies act as a cut-out between consumers and them. Consumers have minimal price sensitivity since their care has already been paid for by their employer in the form of health insurance premiums. Under single-payer, providers would be unable to play insurance companies off one another in price negotiations.

    So it's little wonder that the American Medical Association has been opposed to government-backed health initiatives throughout the 20th century [1]. Both the AMA and the American Hospital Association have joined with the pharmaceutical and health insurance industry to oppose Medicare for All [2,3,4].

    Doctors have also lobbied to limit competition that could drive down their compensation. They have lobbied for caps on the numbers of doctors trained in the US and on Medicare reimbursements for resident physicians. A testament to the success of these limits is that in 2022, a quarter of US physicians were trained abroad [5]. The AMA has opposed expanding the scope of practice for nurse practitioners [6]. Resident physicians are subjected to grueling long hours in what amounts to an institutionalized hazing ritual, with residents working up to 28-hour-long shifts and 80-hour weeks under applicable duty hour regulations. Even these generous limits are routinely evaded by false reporting [7]. The Association of American Medical Colleges projects a shortage of up to 86,000 physicians by 2036 [8].

    Meanwhile, despite most hospitals being nonprofit institutions and enjoying the concomitant tax benefits, they increasingly behave like rapacious capitalists. The Guardian reports [9]:

    > Since the 1990s, hospital systems across the US – for and not-for-profit alike – have relentlessly chased after market power, executing nearly 2,000 mergers with little pushback from overwhelmed federal antitrust regulators and indifferent state authorities. Research from the American Medical Association found that by 2013, 97% of healthcare markets in the US had little competition and were highly consolidated under Department of Justice antitrust guidelines. By 2021, that figure had risen to 99%.

    A 2023 Health Affairs study reported "substantial growth in nonprofit hospital operating profits and cash reserves" between 2012 and 2019 "but no corresponding increase in charity care" [10]. Direct-to-consumer advertising for health services ballooned from $542 million to $2.9 billion between 1997 and 2016 [11].

    Stories have emerged of hospital staff steering patients toward unnecessary procedures and testing [9]; of exhorbitant charges, like $629 to put a bandaid on a finger [12]; and of fraudulent billing practices like upcoding [9]. ProPublica describes the case of Dr. Thomas C. Weiner, an oncologist at a Montana nonprofit hospital who was found to be routinely giving his patients unnecessary treatments. In one case, a patient died after 11 years of cancer therapy from treatment complications despite a biopsy in his medical record showing he never had cancer. An autopsy has confirmed the biopsy [13]. Over those 11 years, Dr. Weiner was paid over $20.1 million, billing up to 70 patient contacts a day [14].

    Just last week, my wife had an otolaryngologist push to perform a closed reduction to straighten her broken nose despite a CT scan in her record showing that the fracture was not displaced. This was the third medical appointment she completed (ER, primary care, specialist) for an injury for which the ultimate treatment was OTC pain medication and ice.

    Insurance executives make easy targets, and they earn their bad rap, but it would be a mistake to ignore the other players in the medical industry. Everyone is at the feast, and we're on the menu.

    0. https://www.healthcare.gov/glossary/medical-loss-ratio-mlr/

    1. https://en.wikipedia.org/wiki/American_Medical_Association#O...

    2. https://www.nytimes.com/2019/02/23/us/politics/medicare-for-...

    3. https://thehill.com/policy/healthcare/482797-american-medica...

    4. The New Yorker: Inside the AMA's Fight over Single-Payer Health Care - https://archive.is/u96Rn

    5. https://en.wikipedia.org/wiki/American_Medical_Association#R...

    6. https://www.ama-assn.org/practice-management/scope-practice/...

    7. https://pmc.ncbi.nlm.nih.gov/articles/PMC3886449/

    8. https://www.aamc.org/news/press-releases/new-aamc-report-sho...

    9. https://www.theguardian.com/us-news/2024/oct/17/indiana-medi...

    10. https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.01542

    11. https://jamanetwork.com/journals/jama/fullarticle/2720029

    12. https://www.vox.com/2016/5/13/11606760/emergency-facility-fe...

    13. https://www.propublica.org/article/anthony-olson-thomas-wein...

    14. https://www.propublica.org/article/thomas-weiner-montana-st-...

  • by emocin on 2/10/25, 12:31 PM

    “Too fuckin bad”