Aussie Medical Care’s Post

#unitedhealthcare #dontgetsick #deathanddying #funeralhome *Under CEO #AndrewWitty United Healthcare has a CUT THROAT POLICY of denying patients critical care need. Mr. Witty profits from this with a whopping $23 million profit made basically, by kicking patients to SKID ROW and #GRAVE! *UnitedHealtcare refuses to pay doctors who treat urgent care without the company's permission. *Catastrophic diagnosis are put in patients chart, using compliant doctors, without their knowledge. This is in fraudulent billing to rob Medicare and, thereby defraud the government of billions of dollars, Senator Elizabeth Warren says. * United health denies 94% of urgent care needs, doctors say, to Boost Profit at the EXPENSE of Patients critical care needs. * "United Health Care denies more claims than any other #insurance" - #FORBES. *# BREAKINGNEWS" ... On July 1, 2021, United Healthcare FURTHER TOUGHENED its claims denial policy deny. Health benefits claims related to emergency room visits WERE DENIED if the PROFIT-TAKING company --- (NOT YOUR DOCTOR) ---determines that the visit was for a non-emergency."  ... In otherwords, IF YOU THINK YOU ARE DYING and rush to the emergency room ...UNITED HEALTH will say .. HOW DO YOU KNOW YOU WERE GOING TO DIE??? ... You should have stayed home and WAIT TO FIND OUT! *UNITEDHEALTHCARE has been accused of using algorithms to deny treatments and refusing coverage of nursing care to stroke patients. SUBSCRIBE to my Sulfabittas Newsmagazine, https://lnkd.in/ekCC_9dD to follow me and learn more.

Great investigative journalism by The New York Times highlighting another way #HealthcareIsBroken in the US. United Healthcare was sued and settled in 2011, but the settlement was only for 5 years. Now, UHC and MultiPlan are shown to underpay "out of network" providers below "customary and typical" rates and then charge 1/3 of the "savings" from underpaying to employers in fees. This leads to billions in fees and patients being stiffed with massive bills. Insurance companies with massive profits shortchange doctors and patients, while ordinary people bear the burden. Check out the article to learn more: https://lnkd.in/eVCiyS84 #HealthcareReform #HealthcarePolicy #PatientProtection

https://lnkd.in/gjNawWAP Here's a great breakdown of the state of our current Healthcare system in the US. In short, it's not great. Here's a few stats that caught my eye: - about 1/3 of working age Americans are uninsured or underinsured - about 20% of insured patients w/chronic conditions avoided medications due to hight costs - More than 1 in 5 insured Americans have medical debt What stat surprised you? #HealthInsurance #USHealthcare #Uninsured #Underinsured

The article discusses the challenges people living with #ALS face in navigating insurance coverage and denials for critical medical equipment and treatments. It highlights how Medicare Advantage plans often deny claims for non-invasive ventilators and other essential assistive technologies, even when prescribed by medical professionals. The article shares the story of Jacob Harper, who faced repeated denials for a prescribed ventilator, and emphasizes that these delays can be life-threatening for #ALS patients. The document provides tips and resources to help the #ALS community navigate this issue, and encourages readers to get involved in advocacy efforts to address the problem.

On September 13, lawmakers introduced the No Surprises Enforcement Act, a bill aimed at penalizing health insurers who fail to comply with #NSA payment obligations. This move comes in response to data from Medicare showing over 16,000 complaints, including insurers delaying payments and failing to issue required #reimbursements or #denials within 30 days. The legislation increases penalties on insurers that do not pay after losing disputes. It proposes fines three times the difference between the insurer’s initial payment and the IDR ruling per claim, along with compounding interest. This bill has my support. Strengthened enforcement is necessary to prevent insurers from exploiting the system and jeopardizing the financial sustainability of healthcare practices, especially smaller, community-based providers. For more information, visit https://zurl.co/1RkN #healthinsurance

Worth revisiting this ProPublica piece. Healthcare insurers must do better.

"Claim-denial rates have been increasing for more than a decade. The health policy and research firm KFF reported that 17% of in-network claims by HealthCare.gov insurers were denied in 2021. The same report found that 41% of appealed claims got overturned, though less than 1% of consumers went through the process." I didn't use AI during the many years I worked with hospitals and health systems on denial management, I just picked up the phone and successfully got 70% overturned via peer to peer conferences. Most of the time, the health plan medical directors were not provided necessary clinical documentation when they made their original decision. Simply reviewing the clinical documentation reveals important facts that lead to overturns. Having also been on the health plan side I can tell you I have overturned many of my denials when the attending physician provided additional information during peer to peer calls. Failure to provide clinical documentation causes many unnecessary denials.

A recent survey by the Commonwealth Fund reveals that nearly half of insured, working-age adults in the U.S. report receiving a medical bill or copayment for services they anticipated would be covered by their #healthinsurance. Further, nearly 20% of insured adults reported unfair #claimdenial of coverage for doctor-recommended services and less than half of those affected challenge these #denials because they don’t realize it is an option. Challenging health insurers can help. Among those who did challenge their denied claims, 50% succeeded in getting their services approved. For those disputing medical bills, over one-third saw their balances reduced or eliminated. The success rate is even higher for Medicare and Medicaid recipients. #DeniedClaims often lead to delays in care and worsened health conditions. The Commonwealth Fund emphasizes the need for stronger consumer protections and increased awareness about the right to appeal. As some insurers report record profits, it's essential to hold them accountable and ensure they meet their obligations to policyholders. Learn more: https://lnkd.in/epzQHEAz

Lawmakers have introduced the No Surprises Enforcement Act, aimed at penalizing health insurers who fail to comply with NSA payment obligations. This move comes in response to data from Medicare showing over 16,000 complaints, including insurers delaying payments and failing to issue required reimbursements or denials within 30 days. The legislation increases penalties on insurers that do not pay after losing disputes. It proposes fines three times the difference between the insurer’s initial payment and the IDR ruling per claim, along with compounding interest. Strengthened enforcement is necessary to prevent insurers from exploiting the system and jeopardizing the financial sustainability of healthcare practices, especially smaller, community-based providers. For more information, visit https://zurl.co/1RkN #healthinsurance

The recent fatal shooting of UnitedHealthcare CEO Brian Thompson has intensified scrutiny of private U.S. healthcare insurers' practices, particularly concerning the denial of insurance claims. Reports indicate that shell casings at the scene were inscribed with the words "deny," "defend," and "depose," suggesting a possible link to insurance industry tactics. A 2023 analysis by the Kaiser Family Foundation (KFF) revealed that insurers on HealthCare.gov denied nearly 17% of in-network claims in 2021, with denial rates ranging from 2% to 49%. Notably, UnitedHealthcare of Arizona reported the highest denial rate, rejecting 49% of in-network claims. Such denials can lead to patients forgoing necessary medical treatments due to financial constraints, adversely affecting public health. While these practices warrant critical examination and reform, it is imperative to address them through peaceful and systemic changes. Violence, as exemplified by the tragic incident involving Mr. Thompson, is neither a justified nor effective means of enacting change. Constructive dialogue and policy reforms are essential to ensure that the healthcare system serves the best interests of patients and the broader U.S. population. #HealthcareReform #InsurancePractices #PatientAdvocacy #ClaimDenials #SystemicChange #HealthcareTransparency #RegulatoryOversight #UnitedHealthcare #BrianThompson #PeacefulReform