I would bet that once the murderer is identified, he will be found to be someone whose loved one died after United Healthcare denied a claim. I think this is so likely that it could help identify him - if they search their records for such cases they could probably use it to find a list of potential suspects.
I have often wondered what insurance companies’ motive is for covering so-called gender affirming care, which is essentially cosmetic surgery. They don’t cover nose jobs, no matter how distressed a person might be at the appearance of their nose. In a time when they are denying coverage for all kinds of necessary procedures, why do the insurance companies seem to be working against their own interests by covering gender medicine, no questions asked?
My mom just had to wait six months for surgery for a kidney stone due to fighting with her insurance company over coverage, when it was obviously medically necessary. The really cynical part of me believes that they know that if they delay procedures for people in their 70s by tying it up with red tape and paperwork, some percentage of those people will die before getting surgery, and so the delays are by design. And while people don’t generally die directly from a kidney stone so they can’t be held legally liable for ill effects on her health, my mom’s health couldn’t really afford six months of constant pain, blood loss, and lack of mobility and muscle loss due to the pain she was in.
I'm not sure I understand the use of the word 'hypocrisy' in this piece. Everyone might need anesthesia at some point; not everyone needs gender-affirming care. These seem like largely unrelated types of coverage, and Anthem's stand on one doesn't mean it is inconsistent about the other.
I get the last sentence in this piece, though — that's a good point.
Is gender-affirming care a standard coverage Anthem offers to all its customers — such as those who sign up on exchanges under the Affordable Care Act? Or is it something it only offers to companies like Edward Jones that want this kind of coverage for their employees? I worked for a company that self-insured its health coverage. The coverage was managed by one of the big insurance companies, but it was not an off-the-shelf policy.
I tried, without success, to get copies of insurance policies from other Fortune 500 companies, to compare the coverage to determine whether the transgender coverage was standard for progressive, large firms, or whether it was a one off from Edward Jones
Also interesting Substacks by Jeff Childers yesterday in his Coffee and Covid post concerning the normalization of mask wearing and John Leake who has written several pieces about who the murderer might be and the clues he left behind.
Don't pretend that it's possible to be anti-so-called 'stupid' govt regulation and pro-regulating health insurance companies at the same time. Anti-govt regulation is a major, if not the major, reason why the health insurance industry has defeated at least 40 years of regular efforts to improve health service availability for American people. You can't have it both ways. Either people accept the importance of govt regulation and work to really understand regulations and how to improve them OR people rant nonsense about stupid govt, big taxes (that pay for most of roads, air traffic control, health professionals training, vital research, etc etc)
Hi Mr. Posner, I'm a fan of your work, especially the JFK and MLK stuff, but I feel that in your urge to point out what you perceive as the unwarranted deference given to gender care, you have made a rush to judgment(sorry) about some of the other controversies regarding health insurance. You repeated the idea that NhPredict, an AI tool used at some points by UHC has a "90% error rate" This is not a fact, but a claim made in a lawsuit against UHC. The claim stems from the fact that 90% of appealed, initially adverse decisions, which had used NhPredict were overturned.
However, only a small fraction of denials were appealed. Why should we use appealed denials as a stand-in for the quality of all denials? 90% does sound like a diabolically high rate, but it's actually just marginally higher than the overturn % for Medicare Advantage prior authorization denials as a whole. In 2022 NhPredict was used for a small subset of care, while across the board(according to KFF) 10% of MA prior auth denials were appealed. 83% of those were overturned. By lawsuit logic, the "error rate" of all MA denials is then 83%. In 2019, before UHC had acquired this AI tool, the overturn rate was about the same for the combined MA insurers as 2022, while 7.5% of denials were appealed(KFF). Meanwhile... a 2019 audit of MA Insurers by HHS found that 13% of prior auth denials should have actually been approved by Medicare rules. This suggests that the overturned appeals rate does not resemble the error rate.
It makes sense that doctors would be more likely to appeal the worst calls by insurers. If they felt they could truly get a reversal in 80-90% of all cases, they might just appeal every denial, not the 10-15% they actually do (2023, KFF). You also mentioned that UHC had among the highest denial rates for claims reimbursement. The idea that they deny 1/3 of claims is based only on information from their ACA plans, and only on the two states available (AZ, TN). We really have no idea how they compare accross the board to other insurers. That info isn't available.
I agree that oversight and regulation are very important in health insurance, but the current debate is full of dubious statistics, or those of limited value and context. As for the tug of war between BCBS and anesthesiologists, that seems like a standard price haggle. I bet you there is some haggling on the price of gender care too.
Gerald, thank you for clarifying many of the danglers out there. It’s truly reprehensible where the healthcare industry is heading. Anesthesia or gender affirming care? One is required for surgeries. The other of course is not. Keep following the money trail! 👍
But… the DEI-like approval of gender affirming care affects placates a tiny portion of the population. It probably costs the insurance company a minuscule amount of $ when compared to the massive number of automatic denials of claims.
Bottom line; violence and murder is never acceptable but there is a simmering hatred for insurance company practices in this country and only federal regulations (which I generally abhor) will stop the unethical practices. For goodness sakes we’ve got stupid government refs on everything from snail darter protection to nutrition guidelines —- I’d say Regulation of the health insurance industry is more important.
Unbelievable! The whole healthcare industry needs a massive shakeup.
It's not hypocracy if the aim is the bottom line. Political posture is part of that.
I would bet that once the murderer is identified, he will be found to be someone whose loved one died after United Healthcare denied a claim. I think this is so likely that it could help identify him - if they search their records for such cases they could probably use it to find a list of potential suspects.
I have often wondered what insurance companies’ motive is for covering so-called gender affirming care, which is essentially cosmetic surgery. They don’t cover nose jobs, no matter how distressed a person might be at the appearance of their nose. In a time when they are denying coverage for all kinds of necessary procedures, why do the insurance companies seem to be working against their own interests by covering gender medicine, no questions asked?
My mom just had to wait six months for surgery for a kidney stone due to fighting with her insurance company over coverage, when it was obviously medically necessary. The really cynical part of me believes that they know that if they delay procedures for people in their 70s by tying it up with red tape and paperwork, some percentage of those people will die before getting surgery, and so the delays are by design. And while people don’t generally die directly from a kidney stone so they can’t be held legally liable for ill effects on her health, my mom’s health couldn’t really afford six months of constant pain, blood loss, and lack of mobility and muscle loss due to the pain she was in.
I'm not sure I understand the use of the word 'hypocrisy' in this piece. Everyone might need anesthesia at some point; not everyone needs gender-affirming care. These seem like largely unrelated types of coverage, and Anthem's stand on one doesn't mean it is inconsistent about the other.
I get the last sentence in this piece, though — that's a good point.
Is gender-affirming care a standard coverage Anthem offers to all its customers — such as those who sign up on exchanges under the Affordable Care Act? Or is it something it only offers to companies like Edward Jones that want this kind of coverage for their employees? I worked for a company that self-insured its health coverage. The coverage was managed by one of the big insurance companies, but it was not an off-the-shelf policy.
I tried, without success, to get copies of insurance policies from other Fortune 500 companies, to compare the coverage to determine whether the transgender coverage was standard for progressive, large firms, or whether it was a one off from Edward Jones
Matt Stoller writes a Substack about monopolies. Friday's is about the murder, and it is not behind a paywall. Highly recommended to all.
Also interesting Substacks by Jeff Childers yesterday in his Coffee and Covid post concerning the normalization of mask wearing and John Leake who has written several pieces about who the murderer might be and the clues he left behind.
Thank you. That sounds interesting.
Don't pretend that it's possible to be anti-so-called 'stupid' govt regulation and pro-regulating health insurance companies at the same time. Anti-govt regulation is a major, if not the major, reason why the health insurance industry has defeated at least 40 years of regular efforts to improve health service availability for American people. You can't have it both ways. Either people accept the importance of govt regulation and work to really understand regulations and how to improve them OR people rant nonsense about stupid govt, big taxes (that pay for most of roads, air traffic control, health professionals training, vital research, etc etc)
Hi Mr. Posner, I'm a fan of your work, especially the JFK and MLK stuff, but I feel that in your urge to point out what you perceive as the unwarranted deference given to gender care, you have made a rush to judgment(sorry) about some of the other controversies regarding health insurance. You repeated the idea that NhPredict, an AI tool used at some points by UHC has a "90% error rate" This is not a fact, but a claim made in a lawsuit against UHC. The claim stems from the fact that 90% of appealed, initially adverse decisions, which had used NhPredict were overturned.
However, only a small fraction of denials were appealed. Why should we use appealed denials as a stand-in for the quality of all denials? 90% does sound like a diabolically high rate, but it's actually just marginally higher than the overturn % for Medicare Advantage prior authorization denials as a whole. In 2022 NhPredict was used for a small subset of care, while across the board(according to KFF) 10% of MA prior auth denials were appealed. 83% of those were overturned. By lawsuit logic, the "error rate" of all MA denials is then 83%. In 2019, before UHC had acquired this AI tool, the overturn rate was about the same for the combined MA insurers as 2022, while 7.5% of denials were appealed(KFF). Meanwhile... a 2019 audit of MA Insurers by HHS found that 13% of prior auth denials should have actually been approved by Medicare rules. This suggests that the overturned appeals rate does not resemble the error rate.
It makes sense that doctors would be more likely to appeal the worst calls by insurers. If they felt they could truly get a reversal in 80-90% of all cases, they might just appeal every denial, not the 10-15% they actually do (2023, KFF). You also mentioned that UHC had among the highest denial rates for claims reimbursement. The idea that they deny 1/3 of claims is based only on information from their ACA plans, and only on the two states available (AZ, TN). We really have no idea how they compare accross the board to other insurers. That info isn't available.
I agree that oversight and regulation are very important in health insurance, but the current debate is full of dubious statistics, or those of limited value and context. As for the tug of war between BCBS and anesthesiologists, that seems like a standard price haggle. I bet you there is some haggling on the price of gender care too.
Gerald, thank you for clarifying many of the danglers out there. It’s truly reprehensible where the healthcare industry is heading. Anesthesia or gender affirming care? One is required for surgeries. The other of course is not. Keep following the money trail! 👍
But… the DEI-like approval of gender affirming care affects placates a tiny portion of the population. It probably costs the insurance company a minuscule amount of $ when compared to the massive number of automatic denials of claims.
Bottom line; violence and murder is never acceptable but there is a simmering hatred for insurance company practices in this country and only federal regulations (which I generally abhor) will stop the unethical practices. For goodness sakes we’ve got stupid government refs on everything from snail darter protection to nutrition guidelines —- I’d say Regulation of the health insurance industry is more important.