Reply to UHC CEO Gunned Down in Midtown Manhattan

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]I heard a breakdown of the CEO's $10 million dollar salary. He made $20 a minute. Compare that to someone making $20 an hour. [/quote]

So? That doesn’t seem exorbitant to me.  An extra few million is a drop in the bucket for their company and wouldn’t even be enough to cover the medical bankruptcy of more than a handful of people. I’ve never had UHC, but no one has to use them.  It’s a free market.  Get a different insurance/work somewhere else if you are so unhappy with your benefits.  I’ve had three different medical insurers over the years and have never had any major problems getting treated or having them pay what they are contracted to pay in my plan. [/quote]

1) I’m afraid your experience is far from universal.

2) Do you honestly think people suffering would not just “get a different insurance/work somewhere else” if that was an option for them? Especially after they’ve gotten very sick and their insurance has decided making them not die is not medically necessary? Why don’t you tell them to just eat cake Marie[/quote]

Can you provide us an actual example of someone being denied standard care?  Not experimental care.  What is the DX and what is the care being denied?  Otherwise you are trafficking hyperbole.[/quote]

Here ya go. Someone on r/medicine asked colleagues to provide examples of egregious denials. 285 replies so far.
https://www.reddit.com/r/medicine/comments/1h8f5yo/assassinated_by_insurance/

Random selection:

-I had a patient die from breast cancer because we couldn’t get a mammogram approved because she was too young and didn’t have the risk factors. Metastasized and she was dead by the time oncology was approved.
-I had a patient admitted to subacute rehab after a fall who BlueCross had dragged their feet on approving authorization for rehab, so was waiting in a nursing home without any therapy. He sat in rehab and then was approved for something like 1-2 weeks total.
He was then cut, while still needing essentially 1-2 people to walk with him due to the deconditioning (in part waiting on authorization), and did not have private funds or medicaid to pay for a long term stay, so the plan was for him to move in with his daughter to essentially provide all the assistance for him.
As he is leaving the facility, before getting into the car, he falls basically three steps outside the door, and has significant polytrauma up to and including a hemopneumothorax and cardiac tamponade from multiple rib fractures.
He spends the next two-four weeks in the hospital, with a pericardial window, etc and complications from the polytrauma.
-We had a patient with horrific low back pain and a lumbar radiculopathy with progressing weakness. We were able to get an authorization for surgery to decompress the L5 nerve root for the worsening foot drop, with the authorization specifying the date range for our planned surgery. Weakness started progressing faster, so we bumped the surgery up a few days to squeeze him in as soon as possible. After the successful surgery was completed the whole surgery was denied by insurance because we did it 2 days before the specified authorization range
.-Here is the most egregious case I've ever heard: Kathleen Valentini

Healthy 47 y/o woman develop hip pain out of the blue
Doctor orders MRI
Health insurance administrator says "no MRI, go do physical therapy for a few weeks"
She had already done PT, which her Doctor had told her insurance company when they ordered the MRI.
They appeal and after 41 days the insurance company authorizes it
Turns out she has a fast-growing bone cancer
Woman goes to MSK to have it treated. Doctors say they would've been able to try chemo had it been diagnosed a few weeks earlier. Instead, they must do radical surgery (amputate leg).
They do the surgery. Margins are positive. She dies shortly after.

Here are some other articles that cover the story:
https://www.wfae.org/health/2023-05-09/her-health-insurer-delayed-her-mri-as-the-cancer-spread
https://casetext.com/case/valentini-v-grp-health-5

-Patient in my continuity clinic has clear superficial venous thrombosis with risk factors of progression to DVT. Firstline anticoagulant: rivaroxiban. Insurance not willing to budge for it, had to work with a coupon or the patient goes on warfarin.

-Rare blood cancer. Not many treatments but a recent one had promising results. FDA approved. NCCN recommended. Insurance denied. Their rebuttal “try the shitty older drug that doesn’t work first. You can’t say one is better without a head to head comparison.” Same day I did the peer to peer (with a semi retired boomer gastroenterologist btw), pt got admitted with renal failure and died 5 days after that.

(r/medicine frequently says the peer-to-peer docs on the insurance side are certified in a specialty that has nothing to do with the condition needing the coverage, having practiced in years, or whose licenses even turn out to be inactive)

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