This country must really be in the crapper for it to idolize a vigilante...

[PeaceWave]

We haven't seen idol worship of ruthless criminals since the Great Depression with Bonnie and Clyde. Is that where we're at now, cheering on those who take the law into their own hands?

[Think. Again.]

1. Yeah, a lot of people are REALLLY going out of their way...

...to sow division.

[questionseverything]

2. The ass used a computer program to deny 90% of claims

Why isn’t the government prosecuting the company for fraud?

[Autumn]

5. He was being investigated for insider trading and fraud. Sens. Elizabeth Warren and Ed Markey

had asked the Securities and Exchange Commission to investigate UnitedHealth for the CEO's stock sales back in April. Insider trading and fraud.

[Silent Type]

9. Nope, it didn't deny 90% of claims or anything close. You misread headlines if

you believe that.

[LizBeth]

51. No just a whole lot of providers having to spend a whole lot of money time and effort to appeal

or challenge the denied claims to get them to EVENTUALLY pay. Right, they did nothing wrong there.

[Silent Type]

54. In most cases, provider's office -- if they know what they are doing -- submits an electronic change of code or medical

records to show coverage guidelines have been met. Sadly, even Medicare puts people through this when claims are submitted that don't meet guidelines. Doctors learn quickly to become familiar with coverage guidelines.

[LizBeth]

64. Not true, they submit info, has not been brought over to main room or was brought over

but went thru the automated processing not a person so it was not processed correctly. The provider has to call to find out what happened to correction if it was made, if it was ignored if a person looked at it, did the person care..... I mean I have been reading your posts and you make it all pink pony and rainbows and that is just not how it works. Then a code editing was implemented, now provider has to submit an appeal to unlock the editing so it can be adjusted, ooops, lost on portal, fax it in... oooops see it there but not brought over then sent to appeal for another up to 60 calendar days but hey... nothing shows on appeal until NAO completes appeal. Then there is the people that do not show if appeal was sent or not so has to be sent again....
I mean, your posts are absolutely ridiculous.

ALL that while waiting cause queue has over 100 calls waiting, for $8.51 for a bill that is $1000 but contract to the insurance pays providers a pultry sum.

[Silent Type]

65. Say you suddenly found yourself working for an insurance company and received a claim that looks like this for MRI--

-- Medicare would pay somewhere between $800 and $1800 depending on type of MRI, whether it uses contrast, etc.
Do you think the insurance company should pay it, or deny it and ask for additional information?


-- Now, lets say you got 3 claims for this patient on the same day with slightly different amounts. Would you deny it and ask for additional information?

-- Now say, Medicare or private insurer has a coverage policy that says they will cover only one MRI per hospital stay, unless there are special circumstances. Typically private insurers copy Medicare coverage policies nowadays. Then you get a bill for 2 in 3 days. Would you deny and ask for additional information?


-- Say you got 2 bills from 2 different physicians/facilities. Would you deny and ask for additional information?

-- Finally, you get a bill that looks strange (like maybe a provider got hacked, and someone is billing multiple services for patients that weren't even seen, would you deny and ask for additional information.

Welcome to the world of health insurance claim adjudication They get millions of claims a day too.

Technical note: The claim the insurance company receives just has a date-of-service, CPT code for service, one or two diagnosis codes, patient and provider identification like a provider number. It doesn't include medical records just a few codes.

[LizBeth]

68. Your argument literally has nothing to do with what I posted.

My point is pretending it is all smooth and easy and fast is simply bullshit and that the insurance companies are not implementing policy to make money off both provider and member at their expense is wrong. There are huge problems in the processing.

You state millions of claims being the issue? Ok, that is still on the company profiting in the BILLIONS to come up with resolutions. Literally the definition of their job and if it is hiring more employees or systems that better service the company or whatever, so be it but that will have nothing to do with purposely and actively working at denying claims to make money and settling for people giving up and pay it.

Are there issue on the medical side? You betcha. Not what my post was about and not going to pretend the insurance companies are not abusing their powers. And I will tell you I have seen very very few claims going to SUI investigations so not like a huge issue out there. And they keep those investigation going for upward of a year, even the legit claims so not like they are not purposely dragging those out too.

[Jim__]

13. There is a claim that 90% of United Health's denials - based on that algorithm - were reversed on appeal.

I haven't seen how that suit turned out.

From YahooNews

...

One lawsuit filed last year against UnitedHealth claims that 90% of the algorithm’s recommendation are reversed on appeal.

The lawsuit states that UnitedHealthcare wrongfully denied elderly patients care by “overriding their treating physicians’ determinations as to medically necessary care based on an AI model that Defendants know has a 90% error rate.”

In court filings, lawyers for UnitedHealth argued that the lawsuit should be dropped because plaintiffs failed to complete Medicare’s appeals process and that their grievances are with the federal government and not UnitedHealth, STAT News reported in May.

UnitedHealthcare and Humana (HUM) did not immediately respond to requests for comment from Quartz.

...

[dalton99a]

22. And consumers rarely appeal denied claims

For ACA plans:

https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/

Consumers rarely appeal denied claims and when they do, insurers usually uphold their original decision. In 2021, HealthCare.gov consumers appealed less than two-tenths of 1% of denied in-network claims, and insurers upheld most (59%) denials on appeal.

For Medicare Advantage plans:

https://oig.hhs.gov/reports/all/2018/medicare-advantage-appeal-outcomes-and-audit-findings-raise-concerns-about-service-and-payment-denials/

When beneficiaries and providers appealed preauthorization and payment denials, Medicare Advantage Organizations (MAOs) overturned 75 percent of their own denials during 2014-16, overturning approximately 216,000 denials each year. During the same period, independent reviewers at higher levels of the appeals process overturned additional denials in favor of beneficiaries and providers. The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided. This is especially concerning because beneficiaries and providers rarely used the appeals process, which is designed to ensure access to care and payment. During 2014-16, beneficiaries and providers appealed only 1 percent of denials to the first level of appeal.

[Dyedinthewoolliberal]

32. What would be interesting data to me

would be extrapolating how much it would have cost United to pay each of those denied claims. I'm willing to guess it would not come close to harming their revenue totals. So I'm speculating they are denying claims because they can get away with it, rather than basing decisions on financial impact to them. This would show us how lopsided and un-scrupulous the industry is.

[RobinA]

69. This Really Doesn't

have anything to do with Advantage plans. Insurance companies deny claims if they are on the wrong kind of paper. Appealing a denial will often (not always) get you a win. IF you have the time and the energy. I appealed a non-payment of a claim of my mother's when she was on my father's Blue Cross. It wasn't super expensive as medical claims go, but it was ongoing. I won after the insurance company didn't even bother to submit information in response to me. My position is to appeal everything that is denied. If you know it was denied. Often doctor's offices don't even request things that they know will be denied, especially by Medicare.

[TheProle]

45. Cite?

The fact that this type of misinformation not only stands here but also has 5 recs is shameful.

[questionseverything]

50. The nyt reported it, as did fox news and the senate democrats

[Autumn]

3. What is it trump says? America is a shit hole country. It fits, Crapper, shit hole. Well done

Last edited Wed Dec 11, 2024, 06:30 PM - Edit history (1)

You tied it together

[Hope22]

4. It's all great as long as those rooting for don't get hit.

Just when you think things can’t get shittier!

[Trenzalore]

6. Well before the 1930s

The banks fucked everyone and cost them all their savings.....so people robbing banks didn't trouble people as much.

[Hekate]

28. Wow, kind of like the for-profit health desurance system we have in the 21st century

Most common cause of personal bankruptcy in the US: medical bills — no doubt due to unnecessary treatments.

[ForgedCrank]

7. Na, this is different

because the victim was someone they don't like.
Imagine trying to write code for a program that determines if someone should be forgiven for a crime or convicted, and it has to follow all of the guidelines set forth by these types of things. The computer would instantly lock up and crash due to all of the conflicts.

[republianmushroom]

8. Yup, they elected to president a convicted felon,

and political members of both parties calling for his pardon.

46 months and counting

[Wounded Bear]

10. IDK, 50 years of comic book heros, including 20 years of making movies out of them...

[Mike 03]

11. The "Vigilante" is a classic American archetype that "we" have celebrated

for centuries in our literature and cinema and real life.

Many people are experiencing conflicted emotions about this.

This discussion was interesting for a few days but it's getting really tedious.

[Shellback Squid]

12. yeah, and Breaking Bad was good too

[Hellbound Hellhound]

15. This country was formed on vigilantes and has been a part of our lifeblood since inception.

Our founding as a colony was declared by vigilantes. Our revolution was begun by vigilantes. Almost every war before Vietnam was started, fought for and ended by vigilantes. And whats-his-name CEO died at the hands of a vigilante.

He's just one more in a long line of dead ends. In this case, more literal than most.

[ananda]

16. Maybe the Magats need to actually see and live through what they voted for.

It looks like it has to get that bad enough for
real change to happen.

And believe me, it will.

And there will be no exceptions for anybody
whatsoever.

[kerry-is-my-prez]

27. What about the Oligarchs? It will be a battle between Trump and them.

I could see Elon running the country. Who does the right like better: Elon or Donald?

[ananda]

33. IMO, it doesn't matter who runs the country into the ground.

It will have the same result.

[Trenzalore]

36. JD Vance is there if Trump goes off script

Trump is a spokesman. He gets to walk around as they play hail to the chief and go to rallies. He isn't running things.

[Meowmee]

44. Orange psycho- he is the messiah to them, their savior

[Kingofalldems]

17. Idol worship of ruthless criminals you say?

Where is your OP on Donald Trump?

[raccoon]

66. Thank you.

[Shrek]

18. Is this about Daniel Penny or Luigi Mangione? n/t

[Skittles]

31. they are both murderous scum

yup

[peregrinus]

19. Just post a story about a dad killing a child predator

And see how many people jump for joy over the death. A good 50% of the respondents would be saying how they would help the dad get rid of the body or that they’d pull the trigger themselves.

[Prairie Gates]

20. You're right: the for-profit healthcare system is a complete disaster, a historic fuck-up

Capitalism is bad for healthcare. Good point.

[Blue_Tires]

21. Rittenhouse is a celebrity millionaire now...

Then there's Zimmerman.

You're acting like the celebration of vigilantism is a recent phenomenon...

[tenderfoot]

23. cheering on those who take the law into their own hands?

I know right?

You're not fooling anyone.

[Kingofalldems]

25. Boom!

[ShazzieB]

24. Who's idolizing a vigilante?

Perhaps you could direct me to those posts, as I have not seen them.

What I have seen is a lot of people (including myself) admitting an inability to get very worked up about the death of a disgustingly rich CEO who has made a fortune off of denying health care to people. I have also seen a lot of very judgmental responses scolding those of us who have expressed an inability to grieve over this, accusing us of all sorts of terrible things.

I am getting very tired of all of the above. I'm not a fan of murder, but I am also not a fan of being told how I'm supposed to feel about something and being judged harshly for not feeling the way someone else thinks I "should" feel.

I wish people would realize that it is NOT possible to dictate how someone should feel about this or anything else. It's time to be adults and stop judging each other.

[SocialDemocrat61]

26. Well said

[ShazzieB]

35. Thanks!

I am just unbelievably sick and tired of all the judgmental posts I've seen here since that guy was shot. People telling others how to feel and judging people for not responding in an "approved" fashion really grinds my gears.

[SunImp]

40. They are virtue signalling over nothing

Hardly anyone is going "Haha, take that rich guy" People are just frustrated over our current healthcare system.

[ShazzieB]

48. Exactly!

You nailed it. We're all frustrated about living in a country that throws people to the dogs when it comes to health care, and people have been letting off steam.

[canetoad]

38. That's a great post Shazzie

You wrote what I was thinking. Thank you.

[H2O Man]

41. The best response.

Thank you.

[leftstreet]

62. +1

[Clouds Passing]

29. Yeah, too many idolizers of dump & co, vigilantes for the 1/10th of 1%

[Skittles]

30. yes

rich scum killing rich scum, NOTHING to admire here

[nini]

34. I don't idolize him, but I certainly have zero sympathy for the victim

The suspect needs to be put away for a longgggg time.

[GenThePerservering]

37. Oh well - how many more threads on this theme?

seems like we've had plenty, pretty much all running to forumla.

[canetoad]

39. Do you remember the scene from 'Amadeus"

Where the Emporer of Austria said, "Too many notes" and Mozart responded with,

"Just as many as are needed".

This is a BFD. It's unprecedented. People need to talk about it. We need to get it all out in front of us. Please don't try to put a lid on discussion.

[LeftInTX]

49. I participated in Medicare for All Rally. Out of over 2.6 million in the metro area only 100 showed up.

https://hebfdn.org/echoes/march-single-payer-healthcare-draws-100-downtown/

After hearing the news that Republicans’ attempt to repeal parts of Obamacare failed in the U.S. Senate in a 49-to-51 vote earlier in the week, the array of marchers felt more motivated to demand universal health care.

People just aren't as motivated as they appear to be. They will turnout for immigration rights by the thousands. They swarmed the streets after Roe was overturned. But for this it's lackluster. And I don't believe a fiery Russian style revolution is the answer. I support free elections, not forcing people to do things by the sword. Because right now at this point, that's about all that will move the needle.

[Arazi]

59. Rallies don't work (anymore)

The PTB just ignore them - or mock them.

There needs to be a different way to get the message out. Im absolutely certain people are passionate about healthcare issues but hitting the streets in protest hasn’t moved the needle on much of anything in decades imo

[LeftInTX]

63. Voting? Well, that's done for a few years.

There is nothing else really.
Well, I can think of things, but they won't work either.

[republianmushroom]

42. And they named the convicted felon person of the year.

Luigi Mangione may wind up as person of the decade or century.

Damn strange world we live in.

[hatrack]

43. Yes, by all means, keep on putting words in our mouths and thoughts in our brains . . . .

I bow in homage to your awesome rhetorical powers!!!

[Emile]

46. I don't see anyone idolizing CEO Brian Thompson?

[choie]

47. The country has been in the crapper

Since it elected a sociopath in 2016.

[lame54]

52. Isn't that what the last election was about?

[JohnSJ]

53. yup

[RockRaven]

55. Yes. Hello? Everyone awake? This country REALLY IS in the crapper.

Being in denial about that, and lamenting the symptoms while doing nothing about the disease, doesn't help in any way.

This country is FUCKED UP and it is about to get MUCH worse.

[Happy Hoosier]

56. Well, REAL life vigilantes, perhaps...

... but virtually all superheroes are basically vigilantes, and people loves them some Batman and Ironman.

[Progressive dog]

57. Apparently to some people murderers are heros

at least if they kill those people that they don't like. They don't even care if they don't know if the victim is responsible for even one death or even serious injury. In an emergency, the law requires that you be kept until stable
I've had several payment denials under medicare advantage but never had to contact the company. All due to incorrect billing by hospital or provider. Insurance company notified me in every case that I was not responsible for the bills.
The easy approval under original medicare is how the Rick Scott medicare fraud got by the CMS for years. That's how so many wealthy people reduce their income taxes, there was no one auditing their tax filings.
Laws are meaningless if not enforced and they can't be enforced if they don't exist but that doesn't mean you can kill someone because you think there should have been a law.
If individuals do not carry health insurance, they are still entitled to hospital emergency care, including labor and delivery care, regardless of their ability to pay. The federal Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395, which is a separate section of the more comprehensive 1985 Consolidated Omnibus Reconciliation Act (COBRA), mandates minimum standards for emergency care by hospital emergency rooms. The law requires that all patients who present with an emergency medical condition must receive treatment to the extent that their emergency condition is medically “stabilized,” irrespective of their ability to pay for such treatment.
https://healthcare.uslegal.com/patient-rights/the-right-to-treatment/

[BannonsLiver]

58. Another thread on this? The sanctimony is knee deep already.

[LexVegas]

61. The grandstanding is overwhelming. nt

[LexVegas]

60. ...

[Meowmee]

67. This country is "in the crapper" because

it just elected a psychopath murderer criminal, again. Vigilantes have always been admired by some here for many years.