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@Priyanka_Dayal What is confirmed here is that @UHC “put the bottom line above [Kate Weissman] as a patient.” @Priyanka_Dayal, you have helped place health payers on notice. Denials for proton therapy and violations of ERISA will not stand. The status quo is unsustainable and #change is coming.
@Priyanka_Dayal @UHC Most painful abt certain aspects of the piece is attempt to provide legitimacy to insurance practices that violate the law & deny millions of valid health claims. Lending credence to hackneyed industry arguments is, to quote a federal judge, “immoral and barbaric.” #protontherapy
@Priyanka_Dayal @UHC (1)”Two analyses, done in 2012 and 2014, found evidence of benefits for ocular, brain, and spinal tumors, and for pediatric cancers. But for other cancers, proton therapy was not shown to be superior to standard radiation.”— Here’s the problem with this analysis . . .
@Priyanka_Dayal @UHC (2) Most ERISA-governed plans do not define “medical necessity” in a manner that requires members to show “an additional benefit” or “superiority” between #protontherapy and IMRT. Instead, while someone is suffering from cancer, insurers decide to inject additional . . .
@Priyanka_Dayal @UHC (3) requirements for a showing of “medical necessity” in their denial letters with a citation, to the very first time, to purposefully narrow, restrictive and profit-driven internal clinical guidelines. These guidelines cite to outdated studies that cherry pick a basis to . . .
@Priyanka_Dayal @UHC (4) deny claims on the grounds that #PBT is “experimental” or “investigational.” @UHC and others ignore the medical evidence provided by treating providers in the administrative record based on a predetermined outcome buried in clinical guidelines which do not even . . .
@Priyanka_Dayal @UHC (5) constitute actual plan terms that govern the claims in dispute. Moreover, @UHC heavily relies on “external reviewers” to provide additional layers of denial yet IROs operate under extreme conflicts of interests because they serve the very insurance companies . . .
@Priyanka_Dayal @UHC (6) whose claims they are asked to review. The IROs cite to the same flawed rationale and studies employed by the insurance companies to deliver boilerplate, template external review decisions. When insurers cite studies that align with the quote above what they fail to tell. . .
@Priyanka_Dayal @UHC (7) the public is that from 2012 to 2014 the Affordable Care Act (@ChuckGrassley) was implemented. In 2012, many insurers were approving #PBT at much higher rates but as soon as the #ACA (#Obamacare) was implemented, insurers inexplicably decided to change their . . .
@Priyanka_Dayal @UHC @ChuckGrassley (8) guidelines, without any additional or new medical evidence, to justify a substantial decrease in #PBT approvals. @UHC spent the better part of 2015-2018 advocating for a public initiative in New York to construct a proton therapy center in Harlem . . . 
@Priyanka_Dayal @UHC @ChuckGrassley (9) So to boil this down, @UHC was investing $ in a proton therapy center, telling public officials that #PBT was not experimental or investigational, all at the same time denying thousands of #protontherapy claims around the rest of the country. Does this sound like the . . .
@Priyanka_Dayal @UHC @ChuckGrassley (10) practices of an above-board and blameless stakeholder in the US health insurance system? The short answer is: no. Insurers have treated #mentalhealth claims #bonemarrowtransplant claims and expensive prescription drug claims the same for years . . .
@Priyanka_Dayal @UHC @ChuckGrassley (11) using the same methods and rationales to deny important treatments to millions of premium paying members. And they do so not at a savings but via a short-sighted financial strategy. Denying #ABATherapy for children with autism only increases lifetime health insurance . . .
@Priyanka_Dayal @UHC @ChuckGrassley (12) costs for those children during their lifespan, for example. The law does not countenance these practices nor does the research support the positions of @ShannonBrownlee and @amitabhchandra2. All of this will come to light and the public will hear how health insurers . . .
@Priyanka_Dayal @UHC @ChuckGrassley @ShannonBrownlee @amitabhchandra2 (13) let down their premium-paying members and subscribers when they most need their insurance to work for them—when they’re dying of cancer and need proton therapy. /end
@Priyanka_Dayal @UHC @ChuckGrassley @ShannonBrownlee @amitabhchandra2 If you want to read more about Kate Weismann’s story, please read the work of an Emmy-award winning @CNN journalist, @DrashmanCNN: cnn.com/2018/08/15/hea…
@Priyanka_Dayal @UHC @ChuckGrassley @ShannonBrownlee @amitabhchandra2 @CNN @DrashmanCNN @AdyBarkan @ewarren @BarackObama @PJK4brainhealth @kennedyforum @HillaryClinton “@UHC told 5 INVESTIGATES that the issue ‘underscores the pressing need to establish and gain widespread adoption of clear, evidence-based treatment standards’ for mental health-related disorders.” The same false premise, different type of health claim. kstp.com/news/wrongfull…
@Priyanka_Dayal @UHC @ChuckGrassley @ShannonBrownlee @amitabhchandra2 @CNN @DrashmanCNN @AdyBarkan @ewarren @BarackObama @PJK4brainhealth @kennedyforum @HillaryClinton My goodness, I’m seeing a pattern here 🤔🧐: “What the Dallas Morning News and Des Moines Register uncovered” were MCOs “focus[ing] squarely on delivering profits to wealthy shareholders at the expense of those most in need of medical care.” disabilityscoop.com/2019/05/06/are…
