Just so you know where I'm coming from, I wrote this about a week ago on Facebook.
"I worked at United Healthcare from 1995 to 2002. They bought the company I worked for, Metrahealth, which was a merger of the health insurance divisions of MetLife and Travellers. I worked for Metlife on The General Motors Informed Choice Plan. The merger took place on 1/1/95. Which means by September of 1995 when we were bought by UHC, I had worked for three companies and never left my desk."
I was posting about the murder of Brian Thompson, the CEO of United Healthcare. He was shot in the back, walking to the entrance of a Hilton Hotel before 7:00 in the morning.
I have walked past this Hilton several times during our various trips to New York. If my memory serves me right, it is where Don Draper would meet Conrad Hilton on "Mad Men."
The killer hopped on a bike, rode away, and eventually caught a cab, which took him to a bus station. This guy ended up in Altoona, Pennsylvania, where somebody recognized him at a McDonald's, called the cops, and he was arrested.
We found out that his guy is a scion of a very wealthy family and wasn't some workin' class Joe killing THE MAN because United Healthcare denied Memaw's heart surgery.
He attended a tony private school and earned a bachelor's and a master's from the University of Pennsylvania, an Ivy League school.
In comparison, Brian Thompson comes from a small town in Iowa, and his father was a grain elevator operator. He graduated from The University of Iowa. The fact he rose to the top of the healthcare insurance industry from relatively modest beginnings is something we used to celebrate in this country instead of shooting in the back.
Like many, I have been disturbed by the reaction of some, mainly on social media, regarding this murder. But social media is social media and you have to take it with a grain of salt.
Instead, I was really taken aback by what some "smart" people said, like a former Harvard law professor (Elizabeth Warren) said.
She said, “Violence is never the answer, but people can be pushed only so far. This is a warning that if you push people hard enough, they lose faith in the ability of their government to make change, lose faith in the ability of the people who are providing the health care to make change, and start to take matters into their own hands in ways that will ultimately be a threat to everyone.”
It is not the answer but a warning to go ahead and pay for non-covered services because the boss man may get shot over it.
In a column in "The Guardian," Arwa Mahdawi wrote, "If you spotted the person who shot Brian Thompson, would you a) turn them into the police or b) continue to go merrily about your day? Judging by the gleeful reaction to the UnitedHealthcare CEO’s murder, 99% of the United States would choose option b."
I know it is a column, and hyperbole is a tool of the trade, but I seriously doubt 99% of the United States would choose option b.
Mahdawi goes on to describe health insurance as a "racket" whose primary goal is to maximize their profits by killing people. Oops, sorry, that is hyperbole again. The goal is to maximize their profits by denying claims. Mahdawi links a CNN article about people complaining about when United Healthcare rejected a claim. Graciously, CCN notes, "stories could not be independently verified by CNN."
I can only tell you my experience working in the health insurance industry for 17 years and working in the revenue cycle of a large health system for 21 years.
We never had a meeting where we were chewed out about paying too many claims. Nobody ever said, "Go out and deny those claims!" A denied claim meant a phone call from the insured, which was almost always difficult.
One time, I took a call that started like this: "I'm going to say this very clearly. If you don't say that Metlife is going to pay my claim, I'm going to take this gun in my other hand and kill myself". (I said, "Can I put you on hold for just a second?" The person explained their issue. It wasn't something to kill yourself over.)
Another time, an insured was upset regarding a claim denied after being medically reviewed by a clinician. He told me, "I hope you have someone you love in the hospital and they die." At that moment, my nine-month-old son was in the hospital with Pneumonia. (By the way, this was about a podiatry claim. And before you can say it, this was long before HIPPA was ever thought of.)
So, no, the people in the insurance companies never denied a claim with glee.
During my time with the insurance company, one of my duties was to process claims for expatriated General Motors employees. I worked on claims from all of these other countries, which are supposedly so much better than the United States.
First of all, you would be surprised how much the charges were similar to those in The United States. The total wasn't as much, but they paid upfront in taxes by the citizens of that country.
Secondly, some countries have a two-tier system in which, yes, you can go to The British NHS hospital, or you could go to the fancy-schmancy hospital Charles and Camilla go to.
When I went to work from the hospital system, I worked on many accounts covered by United Healthcare. United Healthcare has many people covered under self-funded plans provided by the company they work for. This means United Healthcare only administrates the "contract" from the company.
Most of these plans do not have a "pre-existing" condition clause. Some do. It may sound mean, but insuring someone has a pre-existing condition is like selling homeowners insurance to a house that has already burned down.
United Healthcare also owns several smaller companies that sell to small businesses (like UMR and Golden Rule). They tend to have large out-of-pockets, and some have pre-existing condition clauses.
For my United Healthcare accounts, sometimes they paid quickly, and sometimes they did not. (My advice: do not give birth to twins if United Healthcare insures you. Trust me.) But for the most part, I don't remember a delay with many United Healthcare accounts. Maybe I have just forgotten. But they tended to pay the high dollar and the low dollar claims in about the same amount of time.
I would never say the healthcare system in America is perfect. I will say, it seems like every time someone steps in to "fix" health insurance, it seems to get worse.
Healthcare is a complex issue. The idea that it can be fixed by shooting executives is a mental healthcare issue more than it is anything else.
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