A Whistleblower Highlights the Hypocrisy of American Health Insurers

Surgical Anesthesia? No. Puberty Blockers for children? No Problem

The brutal murder of UnitedHealth Group CEO, Brian Thompson, in the streets of Manhattan, has elicited widespread condemnation but also unleashed an online tsunami of celebratory memes and praise for the killer. The polarizing reaction has put a spotlight on the deep-seated animosity that many Americans harbor toward health insurance companies that often deny critical medical claims to protect profits. As they reject essential medical treatments, a corporate whistleblower recently provided me an internal health insurance policy that revealed they are also green-lighting expansive “gender affirming care” benefits for employees and their dependent children.

Under Thompson's leadership, UnitedHealth had one of the industry’s highest rates of claim denials. A Senate subcommittee report from October found that the company denied requests for costly post-acute care at triple the rate of less expensive treatments. Worse, the insurer used an artificial intelligence-driven claims process with a 90% error rate in determining medical necessity. The industry-leading denial rate was good for shareholders but created a legion of angry patients who felt subordinated to the company’s bottom line profits.

The backlash has prompted some insurers to reconsider controversial policies. Last week, Anthem Blue Cross Blue Shield, one of the country’s biggest insurers, announced it would halt a policy change that limited reimbursement for anesthesia during surgeries.

Yes, you read that correctly.

Anthem BCBS had quietly rolled out a policy in three states in which it set an “appropriate number of minutes” for surgical procedures and refused to pay for anesthesia that exceeded the limits. Complications that extended surgery times made patients responsible for the costs.

The Anthem policy had survived nearly a year despite vociferous industry opposition from the American Society of Anesthesiologists. However, Anthem only backtracked following Thompson’s murder.

I was acutely aware of the extent of the hypocrisy of Anthem’s ‘let’s limit reimbursement for surgical anesthesia’ since I had recently received from a whistleblower a copy of a corporate “LGBT+ Benefits Guide” from the same insurer. In the Anthem healthcare policy offered by Edward Jones, a Fortune 500 firm that is the largest U.S. financial services company in the number of financial advisors, it has a section titled “Transgender-inclusive health benefits.”

“Our medical plan provides gender-affirming health benefits to associates and dependents who have a diagnosis of and meet Anthem’s clinical requirements for gender dysphoria.”

The plan then lists what “gender-affirming care includes”

• Hormone-replacement therapy including puberty blockers for youths (where allowed by law)

• Reconstructive chest, breast and genital surgery.

• Other services, such as facial feminization surgery, voice modification surgery, tracheal shave/thyroid reduction surgery, etc.”

Edward Jones employees can qualify for “family-oriented and surgical recovery leave” for themselves, or “a loved one [who] receives gender-affirming surgery.”

If an Edward Jones employee, or dependent, “must travel more than 50-miles from your home to receive in-network gender-affirming surgery because it’s not available in your area, our medical plan covers up to $50 per day for one person and $100 per day for up to two companions in travel and lodging expenses.”

Who does Anthem list as “eligible dependents?

• Legal spouse.

• Edward Jones-recognized domestic partner

• Children born to you, adopted by you or waiting to be adopted by you; stepchildren; children for whom you are the legal guardian; foster children; and children and stepchildren of your domestic partner.”

Requests for comments from Anthem or Edward Jones went unanswered.

As someone who has extensively covered corporate abuses in the healthcare industry, including in my 2020 book PHARMA: Greed, Lies, and the Poisoning of America, I’ve documented countless ways in which profits are prioritized over patients. But the murder of UnitedHealth’s CEO has brought fresh attention to the role of private insurers in perpetuating public mistrust. With healthcare decisions, as in the case of Anthem, to prioritize gender-affirming care while dialing back on such basic needs as anesthesia for the full length of a surgery, it is little wonder that so many Americans feel abandoned by a system that seems increasingly designed to work against them.