Damian Caraballo MD Profile picture
Dec 5, 2024 11 tweets 2 min read Read on X
If you want to see why people are so vicious towards United Healthcare right now, let's do a thread on some of the most egregious health insurer behaviors 🧵
1) United Healthcare is 8th largest company by revenue in the WORLD. It made $389B last year...$2B less than Apple. It made more money than Exon, Microsoft, Samsung, JPM

United Healthcare also denies 32% of its claims...highest among health insurer
2) United is being sued for making an auto-denier AI program "known by the company to have a 90% error rate, overriding determinations made by the patients' physicians that the expenses were medically necessary." This directly resulted in multiple elderly deaths in midwest
3) Despite making more money than GM & Ford combined, UNH was found by a govt Watchdog of defrauding Fed govt of $3.2B in extra federal payments for health related assessments.
4) UNH is most famous for the $35 Ingenix lawsuit in 2000's. In it, they used a database to improperly reimburse MDs for services. The lawsuit used proceeds to start FairHealth
5 Ingenix was reborn as Optum. Maybe you heard of the Optum CEO during the Ingenix scandal Andy Slavitt. He was an architect of the ACA & became CMS director under Obama.
6) since Andy Slavitt took over CMS in 2014, $UNH stock is up 790%. Out of pocket expenses health insurance premiums are up 67% since 2008. Image
7) 80% of US bankruptcies due to medical bills had health insurance when they got sick. While out of pocket costs have rocketed up,
8) here's health insurer premiums past 25 years (up 213%) mapped out vs BIG Health insurer stock prices since ACA (up >800%) Image
Image
9) so you see, there's a lot of animosity towards the 8th largest company in the world, who's practice is is to deny care & hurt Americans while their stock price has surged >800% since ACA.

It's time for @TheJusticeDept to break up Big Insurers
*Ingenix was $350M lawsuit.

nytimes.com/2012/04/24/nyr…

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More from @813JAFERD

Sep 25, 2023
US Health Insurers have managed to create a new "Surprise Bill" for patients--walk w/ me through this thread:
1) Step one was passage of No surprises act. This ended balance billing and essentially killed off Envision and Team Health. Except insurers didn't plan on having Ind. Dispute resolution (IDR, ie arbitration)
2) so insurers used their backdoor channel at HHS to skew the IDR rules to included QPA--essentially the in-network rate. Except groups like the @texmed took them to court and won (4 times now). So instead, they got HHS to defund and under staff IDR (no cases since august)
Read 11 tweets
Jul 17, 2023
About 7 years ago, after Zach Cooper’s “Surprise” Bill paper, media & Congress started reporting costs as %Medicare rate. Ever wonder why? 🤔 (thread) #MedTwitter Image
1/ Med Economists love using % of medicare for physician reimbursement instead of actual price. Why? Medicare rate is a made up, mandated rate by CMS. Image
2/ Could it be that Medicare rate, which is held back artificially low, is an arbitrary, intentionally deflationary price surrogate. Goal of medicare is to insure as many as possible, not show actual value of care Image
Read 10 tweets
May 17, 2023
Time for some dystopian health insurer fun facts…topic today is prior authorizations (PA’s for this thread) 🧵

kff.org/medicare/issue…
1/ in ‘21, more than 35 M prior auth requests were submitted on behalf of Medicare advantage enrollees. That’s over 1 prior authorization for EVERY SINGLE MA enrollee (30.12 M)
2/ Highest utilizers were @ElevanceHealth (Anthem), @Humana, & @Centene
Over 2M PA’s were denied.
@cvs & @KPMemberService (Kaiser) denied the highest, at 12%.

Smile boys, your policies are literally killing Americans cancertherapyadvisor.com/home/cancer-to…
Read 11 tweets
Feb 1, 2023
After our @HCMADocs meeting with local legislators, it's time for a PBM thread:
1/ First off...it's really complicated. On purpose. B/c every arrow in this flowchart is money Image
2/ Here's the culprits. You'll notice it's the usual suspects, aka US Healthcare Insurance companies. For illogical reasons, Congress has allowed a $900 B industry to own health insurance, medical data, doctors, pharmacies, PBM's, and get this...GPO's (more later) Image
Read 23 tweets
Nov 30, 2021
Highlights from Teamhealth vs United Healthcare lawsuit 🧵 globenewswire.com/news-release/2…
1/ United colluded & had editorial control over @Yale professor Zach Cooper’s Surprise Billing study which became basis for No Surprises Act. This study was heavily cited by insurers in both passing law & HHS IFR ruling, which we argue sets price ceiling on MD reimbursement
2/ United intentionally went out of network which caused Surprise Bills for its members
Read 9 tweets
Nov 30, 2021
Medical Myth of Day: Increasing access to Urgent Cares & After Hours Practices saves money by eliminating unnecessary ER visits 🧵
1/ Wang et al recently studied affect of increasing Urgent Cares (UC’s near an ER
2/ what they found was interesting: While it decreased low acuity (eg a surrogate for “unnecessary”)ER visits by 39%
Read 9 tweets

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