So far the company has not released an “official” answer to the news station but these guy play for dollars only, as the United CEO says, “our shareholders will prosper”.  Nothing this company does surprises me any more and we have the United “Manifesto” in the OC where I live with their non profit subsidiary working hard to build for profit businesses.  There are so many entities they either own outright with a subsidiary or they create another subsidiary and get 51% controlling interest with merging a company in that they want.  If you have never seen their truckloads of subsidiaries, take a look and you will find a lot of surprising companies listed along with one that does hospice for profit and you can read about their bank.  

Back when the Tri-Care bidding was taking place when Health net almost lost the northeast and during the time of re-examining the bids, they had to sell part of their business to United as the loss  of the Tri-Care business was that substantial and perhaps these are some of the “old contracts” that they can’t reduce down..could be.  Health-Net did not lose the contract as Aetna, who originally got the bid cheated. 

UnitedHealthCare Buys a Portion of Health Net in the Northeast
United HealthCare Purchase of HealthNet in the Northeast Did Not Include Transfer of Employees

Maybe these are some of the doctors they can’t pay less than Medicare rates as the  AFFP confronted them about this at the end of last year.  I have heard it here too from doctors in the OC as the very complex contracts that doctors have to sign with some algorithmic computations in them allow that to happen so you don’t see it up front.  The reports say they are cutting the most expensive doctors with the sickest patients.  I keep telling everyone they do business analytics by the minute and that’s exactly why our HHS Secretary is in the hole all the time as she gets duped and duped again. 

If you go back in time to the out of network payments United has been using their math business models for a long time to profit..the AMA settlement of 15 years of short paying doctors and hospitals so again to not have one eye in the back of your head open dealing with this company is a mistake.  Everyone was duped with the United math models for 15 years and the other major insurers all licensed it too, so they got stuck with lawsuits too when Cuomo figured out the bad math.  If they don’t get what they want, they sue and they did put a Blue Cross subsidiary out of business on the west coast that DOD members wanted to keep. 

Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?
United Protesting Yet Another Contract Award–State of Georgia Where They Claim “It Was Rigged”…

The company did say about 1500 primary care and 4000 specialists will be cut as of February 1, 2014 so we have an “insurer too bit to fail” and like I said above look at the truckloads of subsidiary companies they own or have 51% controlling interest.  The US Supreme Court gave doctors a little leg to stand on with a ruling that doctors can now group together and litigate as all the United contracts said they could not so it was always the one doctor against the big conglomerate.  It appealed all the way up to the Supreme Court. 

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

After you read this article scroll on down to the footer and watch the videos, especially the one about the Quants of Wall Street so you understand what math models do as United has a few hundred quants and can’t hire enough and see how the models are tweaked and how they can lie with altering risk.  Insurers do it just like the banks.  They have former HHS Regulator Steve Larsen working for them as a big VP and he was accredited with writing a lot of the Healthcare law..and they hired the former Assistant US Attorney General of Minnesota as general counsel and after that happened the lawsuits seems to grow as well. 

All I can say is Gov better learn how to model and hire some data sleuths on their side, i.e. Quants that have been on the other side and help educate them on what math models do, how they are written and how the models work with day to day business intelligence analytics.  BD   


Those letters were sent out to doctors caring for 'Medicare Advantage' patients.
It's a plan, marketed to Seniors to provide additional services through UnitedHealthCare.
A mix of primary care and specialty doctors are affected by it. And it comes at a questionable time.
Open enrollment for Medicare starts next Tuesday, and it's still not clear at this time as to which doctors are still in the United network.   

http://www.wtnh.com/news/health/thousands-of-doctors-fired-by-united-healthcare

1 comments :

  1. This is also an issue in Ohio and even though we requested a hearing from UHC they have not yet responded and are sending letters to our patients saying that we will not be in network in 2014. Sounds like they've already decided even before we get a chance to plead our case!

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