This is the first I had seen from this state and we know that in many states as you have seen here, along with the lawsuit filed in Connecticut that this is move that the “business intelligence” algorithmic formulas used by Untied at work again.  I really do wonder how they can accurately keep all of their numbers together at times.image  The company now gets 1/3 of their revenue and profits from their Health IT end of the business, Optum and/or Optum Insights.  Here’s a link to the SEC Tiered subsidiaries of 15 pages worth and this doesn’t cover other interests they have all over to where they own 51% of many other entities. 

I don’t know about the pay structure in Missouri but I am hearing more and more from doctors in California they they are paid at rates less than Medicare in California via the use of complex and difficult to understand contracts.  There’s a lawsuit here too for refusal to cover lap bands with United. 

There’s also some investing and ownership with with surgical centers.  We are all aware of hospital systems buying up surgical centers and there’s also insurance company subsidiary action here too.  Via the MemorialCare subsidiary of Optum, the subsidiary of United HealthGroup created a new venture or subsidiary called Beach Surgical Holdings, LLC in February of 2013

“Beach was created in February when the foundation entered a joint venture with Birmingham, Ala.-based Surgical Care Affiliates LLC.”

It’s not just seniors as in a non related post, kids are out here too….the algos for profit don’t care.  But if you want urgent care they’re building clinics for that now.  This hospital since I added my blog post has now announced they are suing United over their contract issues. 

United Healthcare and I. DuPont Hospital Fail To Reach An Agreement on Contract- This Time It’s the 33,000 Kids That Have To Find New Doctors and Hospitals Or Change to An Aetna Medicaid Plan

But United still wants some of these Medicare Advantage contracts though as they went out and bid and won this contract only to find out the left algorithm didn’t know what the right was doing and there were no providers to see these Medicare Advantage patients so they lost this contract.

Howard County School Board in Maryland Rescinds United Healthcare Contract As Retirees Didn’t Want the Medicare Advantage Plan, No Providers Available..

I guess too though location has something to do with how they adjust their business formulas as inimage certain areas of New York it’s no problem to kick out a check for $175.000.00 (link below)plus interest for a $12-18k (estimate) hammer toe procedure.  I just wondered on that one as to where the FAIR data base was to calculate fair out of network charges?   United used to run that business until Cuomo in New York caught them cheating and short changing doctors, patients and hospitals for 15 years by low balling the numbers used to calculate, and AMA settled the lawsuit. 

They worked the numbers and cheated and didn’t have to admit any guilt so I guess even this banker and his wife in New York went through the ceiling when they saw the bill for the toe procedure.  You can charge a cash celebrity what the doctor wants but when it goes through commercial insurers is there a special “bankers” out of network allowance?   

$175,098.80 To Fix A Hammer Toe Billed by New York Podiatrist And the Insurer Paid It, Well Sort Of As They Sent the Check to the Patient By Accident, A New Investigation For “Out of Network” Charges Has Resulted

Like I posted a short while back, we still have death panels but they are not people but rather math formulas and algorithms that do the job and kick you in or out and deny access to something you need for care.  These death panels may function one algorithm at a time though.  BD 

Death Panels Have Not Vanished, Just “Re-invented” As Powerful Algorithms That Run On Servers 24/7 Making Life Impacting Decisions About All of Us - Flawed Data Driven Attacks of the Killer Algorithms Persist

So one more state taking United to task with a scathing letter.  You almost have to laugh at the quoted comment below though “these changes are aimed at improving member experience”..huh…these members are getting their experiences shut down, right?  BD 

The Missouri State Medical Association accused UnitedHealthcare on Friday of attempting to push out the state’s sickest elderly patients from its Medicare Advantage plan by terminating hundreds of physicians.

Thomas L. Holloway, executive vice president of the state’s largest medical association, wrote in a scathing letter addressed to UnitedHealthcare president and CEO Stephen Hemsley, that the insurer’s planned reductions to its Medicare Advantage network in Missouri appeared to be aimed at eliminating the plan’s most costly patients.

“While these changes are aimed at improving the member experience, we understand that any plan changes can be unsettling,” she said. “We regret any inconvenience our members may experience, and are working to make their transition to a new physician as smooth as possible.”

The changes, he argued, will force many elderly patients to either find a new participating provider or incur significant out-of-pocket costs to continue treatment with their personal, out-of-network physician.


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