Given the way United Healthcare is organized, with Optum as a second party that all claims or other billing issues is directed to, this allows them to very effectively point the finger at each other whenever there is a dispute. Optum in turn owns a lot of care providers including a ton of providers in my area. They have used this as a cudgel in the past, as someone I know was slammed with a bill during Optum's takeover of one of their providers. The Optum employee wouldn't provide any information about the charge and simply fired them as a patient for not paying it. Because Optum is buying up clinics left and right where we live this person has lost access to their PCP on multiple occasions as Optum buys more and more healthcare groups.<p>UHC and UnitedHealth group need to be broken up, and these incestuous relationships between insurance companies, private equity companies, and care providers need to be stopped by the SEC, because their only purpose is to exploit the wrapping up of care providers under one umbrella to extract more money for less work from people seeking essential services.
Go after all the healthcare giants. If people knew even half of how consolidated their treatment was, they would riot.<p>For those who don't know about the significant conflict of interest present here:<p>1. United is a health insurer that has to make payments for people's<p>2. United owns several physician networks (totaling 90,000 physicians), who then determine what your care should be—no conflict with the fact that they pay the bills...<p>3. United owns Optum, which determines how much your drugs are going to cost, and of course, who makes them—brand vs. generic, etc.<p>4. Optum runs its own mail order and specialty pharmacies. Optum also writes your care plans for many chronic diseases and ships medications all over the country.<p>5. Optum could require their own customers to use their care plans and software in order to receive medications at all, or mark up the price for anyone who doesn't.<p>Let's step through a workflow.<p>You, a patient on United, go to a physician for treatment. Later on, you get referred to a specialist, then get diagnosed with a chronic disease and need medication that you receive delivered monthly.<p>That pans out to:<p>United pays United, who refers you to United, that forwards you to Optum (owned by United), who gets paid by United. Each and every month.<p>Let's say you find a better deal for your medication at another pharmacy. Too bad, its not going to be in your network and Optum will no longer cover it.<p>How is a health system or an independent supposed to compete with that level of integration?<p>This, of course, does not result in any savings or quality of life improvement for the patient or the physician. United and Optum charge the same prices as everyone else, or more.
I've had United for a little over a decade, and overall I have to say it's been pretty good. My wife was hospitalized for about a month with our first born, racking up hospital bills over half a million USD. I think I paid about $3500 out of pocket. Then, a number of years later, the same child had her appendix removed. Again, terrifying bills, and about $3500 out of pocket.<p>That being said, after the second event, we had discharge orders from the surgeon that included very specific conditions for when we should bring her in. When some of those conditions presented, we brought her to her (in network) primary care physician, whose office is (incidentally) in our in-network hospital. The physician agreed with our having brought her in, and recommended a CT scan. My daughter was sent down the hall from her in-network pediatrician to the in-network emergency room where the CT machine was located. CT scan proceeded, findings were good, and my daughter recovered just fine.<p>So imagine my surprise when I get a bill for the CT scan. After many phone calls, emails, registered letters, etc. the final determination was that the ER was, at the time of the events in question, had been staffed by an out-of-network third party and thus would not be covered.<p>Now in the scheme of things, the CT scan was a drop in the bucket compared to everything that <i>was</i> covered, and I'm very thankful for how things worked out. But the principal of that situation really left a bad taste in my mouth. We had no reason to suspect that the CT scan wouldn't be covered, and were in no way advised as such. Doesn't seem right.
My "favorite" story about UHC is from a provider perspective.<p>Taking a page from Section U in The Rainmaker ("deny all claims"), they went through a phase where multiple people took them to court over HEMS (helicopter EMS) transport denials, including from the scene of serious car accidents, due to lack of "pre-authorization".<p>Apparently in their mind, us paramedics (or maybe the chopper pilot) should have been calling their 800 number as we stabilized our patient...<p>"This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the hospital due to extensive multisystem trauma but we need a pre-auth. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, I know, I know, sorry, it's a bit loud with the jaws of life and the engines... What's that? Um, sure, yes, I can hold for a nurse consult..."
I think the main problem is lack of free market. Oligopolies are part of the problem, but an equally large part is lack of choice from employes. Many (most?) insured in the US get their healthcare through their employer. You get maybe 2 choices of insurer, often only one. You’re not going to get a new job to switch insurers. The people negotiating the plans are too far away from the people receiving care (it’s probably the finance people anyway). Not everyone has the same healthcare needs or lives in the same area, group plans don’t make sense in today’s world.<p>The government should be promoting and incentivizing ICHRAs and similar. If you haven’t heard of ICHRAs they allow employers to give you a stipend for healthcare. You get to choose your plan (including open marketplace plans, which have some affordability regulations), you can use it for copays or to just pay for stuff out of pocket. You can choose a catastrophic plan and get insurance / a plan from your PCP so you never have to worry about “network” changes. And it’s tax free for employers and employees. Cheaper for employers too, they don’t have to hire benefits administrators and negotiate with brokers/insurance companies.<p>If you’re a company, especially a mid to small sized one, I highly encourage you to look into ICHRAs.
All health insurance companies need to die. They are all crooks and frauds and are using an outdated system in our country siphoning money from families.
We signed up for a United Healthcare plan a couple years back. It showed a bunch of Doctors in network. Once we were on the plan, 90%+ of the Doctors told us they didn't accept United Healthcare or weren't accepting new patients. We couldn't find quality Doctors near us as a result. Ended up having to switch off United Healthcares plan as a result. Certainly felt like it was false advertising to say all the Dr's are in network just to find out none of them will treat you.
There's also this : <a href="https://www.reuters.com/technology/cybersecurity/cyber-security-outage-change-healthcare-continues-sixth-straight-day-2024-02-26/" rel="nofollow">https://www.reuters.com/technology/cybersecurity/cyber-secur...</a> , this hack caused by malware from 2021, caused huge portions of their employee base tied to optum and their change healthcare acquisitions to be unable to work for days (and it's still ongoing!). I guess their employees got a "vacation" out of it while everyone else waiting on prescriptions at CVS, etc got shafted. It literally took a huge portion of the US pharmacy network to go down for the US to realize what a big problem UNH is.
Optum is the most garbage organization that has absolutely ruined local healthcare. I go out of my way to find places that aren't affiliated, even though they're much further distance, just to avoid them. It's about time this happened.
Not shilling here, merely impressed by the work of journalist Marshall Allen—he has a book "Never Pay the First Bill". Search around on podcasts and YouTube for some interviews to get the jist.<p>I've bought a few copies for friends that had expensive health issues and have used the techniques on relatively small stuff for myself.
I started following this person called Doctor Glaucomflecken who makes funny short skits on TikTok and YouTube, and that was how I first learned about United Healthcare. The wild thing is that he makes these funny videos so you think it's a joke, but then you look it up and realize it's real. Healthcare in the US is not in a good place, so this definitely sounds like a good action.
Covered this space from an investment angle for nearly two decades. These guys are crooks. It’s a controversial take but UNH (and everything else in healthcare) became so big directly as a result of PPACA. That should really be Obama’s legacy. US healthcare system is broken because both the right and left are completely bought by these monsters.
Related:<p><i>US pharmacy outage triggered by 'Blackcat' ransomware at UnitedHealth unit, sources say</i><p><a href="https://www.reuters.com/technology/cybersecurity/cyber-security-outage-change-healthcare-continues-sixth-straight-day-2024-02-26/" rel="nofollow">https://www.reuters.com/technology/cybersecurity/cyber-secur...</a><p>(<a href="https://news.ycombinator.com/item?id=39524514">https://news.ycombinator.com/item?id=39524514</a>)
I want to know who exactly the “industry officials who compete with the healthcare giant” they’re interviewing are. The price fixing and collusion go way way deeper and broader than just United Healthcare and Optum.
Just to provide a counter point to all the anti-UHC complaints here - some of which may be legit - my last job had UHC insurance, without question the absolutely best insurance I have ever had in my life - literally everything was covered, no denials, no referrals needed, very reasonable co-pays and honestly felt like I had a truly gold-plated health coverage.<p>Now I switched to a new job, with a much small regional health insurance provided by new employer- and it sucks. Higher copays, more hoops to jump thru, penalized for going out of network (and that network is much smaller than UHCs) etc.<p>I for one don't care how big UHC is, how many additional related businesses they own including pharmacies etc, especially if it allows them to control costs better up and down the delivery chain - if, as a consumer, that gives me excellent service and limits my out-of-pocket expenses, I see that as a good thing, so I am all for it.
All the awful reviews of united here, and yet it's reviewed as one of the highest rated insurance agencies (for example see <a href="https://www.forbes.com/advisor/health-insurance/best-health-insurance-companies/" rel="nofollow">https://www.forbes.com/advisor/health-insurance/best-health-...</a>)<p>Are these reviews completely paid for? What's going on here? Or are all the options awful.<p>I am in the position to choose our provider at our (small) company, but between Gusto and JustWorks and the majority of our employees being in Texas there was slim to none options except united.
><i>UnitedHealth executives have said that Optum and UnitedHealthcare don’t favor one another</i><p>Yeah, that's laugh-out-loud levels of bullshit.<p>You think executives are just going to admit to facilitating what effectively is a form of racketeering?<p>NINJA EDIT: The Optum arm itself needs to be broken up into a bunch of smaller pieces. United Healthcare also needs to be broken up.
Finally! Now do the Blues (please, please DOJ and FTC). And the major inpatient and provider oligopolies.<p>Market concentration across many layers is a huge reason we spend 17% of US GDP on healthcare.
How is there an argument of wrongdoing here when the regulatory approach for healthcare is still based around this idea that multiple anticompetitive arrangements (the price fixing between providers and "insurers") will somehow actually create competition? Like don't providers have to be standing alone as their own market independent of payer before one could say that UHC's actions here are specifically anti-competitive, rather than just the HMO system working as envisioned?
The healthcare system in the United States is so hard to navigate. I recently switched to Sedera (<a href="https://sedera.com/" rel="nofollow">https://sedera.com/</a>). They to have much better incentives, better prices and service. We'll see how it goes
I see a lot of comments on here about how to "fix" the system, ranging from informed to terribly uninformed.<p>There's one thing that I haven't seen mentioned that would be a great place to start:<p>Be healthy.<p>I know, many people don't have that choice. There are hereditary conditions, and accidents and chronic conditions - I know. I work in the industry.<p>However, as a nation we've largely chosen to outsource our health.<p>It makes sense, in a world that operates around specialization, we tend to follow those patterns for everything. Electrical problem? Call electrician. Plumbing problem? Call plumber. Health problem? See a doctor.<p>It's understandable, but it's reactive and not an optimal solution for wellness.<p>Consider these leading areas of healthcare costs in the U.S.:<p>Obesity: 173 billion per year. [1]<p>Diabetes: 412 billion per year. [2]<p>Heart disease & stroke: 216 billion per year. [1]<p>Smoking: 240 billion per year. [3]<p>And alcohol just makes all of that way worse. [4]<p>Most of the above can be controlled.<p>If we really want to reduce costs and improve healthcare, I think it's best to start at home and work towards making sure we and our families are healthy and fit. It's not easy, and it takes a lot of education and work, but it's worth the effort.<p>If Americans did that, we could reduce healthcare spend and ease the burden of stressed medical systems. We'd all be healthier and happier.<p>It's not the whole answer, but it would be a great start.<p>The path we're on seems to be trending in the opposite direction. Processed foods, sedentary lifestyle, addictive additives, high stress jobs - it all adds up.<p>I think rising healthcare costs are (amongst other things) a symptom of our choice to deprioritize our wellness.<p>Sure there are lots of opportunities for disintermediation in the gordian knot of U.S. healthcare, and we should pursue good solutions.<p>But we should start with what we can directly control: our diet and fitness.<p>[1] <a href="https://www.cdc.gov/chronicdisease/about/costs/index.htm" rel="nofollow">https://www.cdc.gov/chronicdisease/about/costs/index.htm</a><p>[2] <a href="https://diabetes.org/newsroom/press-releases/new-american-diabetes-association-report-finds-annual-costs-diabetes-be" rel="nofollow">https://diabetes.org/newsroom/press-releases/new-american-di...</a><p>[3] <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/cost-and-expenditures.html" rel="nofollow">https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast...</a><p>[4] <a href="https://www.sciencedirect.com/science/article/pii/S2773065422000347" rel="nofollow">https://www.sciencedirect.com/science/article/pii/S277306542...</a>
UnitedHealth is by far the worst health coverage I have ever had. They are so bad at paying claims that our local hospital network has dropped them; all of our emergency care in the immediate region is now out-of-network. They absolutely are criminals and deserve to be put out of business.
Most health issues are connected to food. Synthetic sugars, seed oils, herbicides, pesticides, and diminished quality of vitamin mineral content. If you think the heal5 care industry has it locked up look into ag.