United health care ceo shot dead

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Gern Blansten said:
Yes. You are correct. I didn’t read far enough into the post that @aneftp made that you responded to. I stand corrected.
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Most things are political.

United healthcare has gotten richer (along with Lilly) and other healthcare companies with ACA.

We as anesthesiologists completely lost control of the private market due to the ACA. Which encourages mega mergers (of hospital corporations)

Yet when usap forms and the “doctors” started colluding and over charging united healthcare due to market share

United healthcare paid off congress to pass the no surprise act. Because United healthcare could not bully the AHA entities. It was easier to bully little usap to death.
 
aneftp said:
Most things are political

United healthcare paid off congress to pass the no surprise act. Because United healthcare could not bully the AHA entities. It was easier to bully little usap to death.
Click to expand...

You anesthesiologists griping about the no surprises act are fu**ing greedy. It's the right thing to do for the patient. When the patient chooses an in-network surgeon/proceduralist the patient has no control over whether their contracted anesthesia provider is in-network.

A few years ago, I needed a rather urgent EGD and my gi doc worked me in the next day. Everything was fine until UHC denied the CRNA because he was out of network. Contacted the billing officer and they said they were sorry, they thought their providers were with every UHC plan. Well not my plan, I guess.
 
psycho-matic said:
You anesthesiologists griping about the no surprises act are fu**ing greedy. It's the right thing to do for the patient. When the patient chooses an in-network surgeon/proceduralist the patient has no control over whether their contracted anesthesia provider is in-network.

A few years ago, I needed a rather urgent EGD and my gi doc worked me in the next day. Everything was fine until UHC denied the CRNA because he was out of network. Contacted the billing officer and they said they were sorry, they thought their providers were with every UHC plan. Well not my plan, I guess.
Click to expand...
Yes and no. It’s evil vs evil. Insurers and the AHA battling each other.

You don’t get it.

Facilities reimbursements (especially mega hospitals mergers) jack up insurance reimbursements for themselves. Look at any facilities reimbursements from mega hospitals. It’s huge

Add in the fact anesthesia is a huge money loser for Medicare reimbursement.

A surgeon will get reimburse 60-70% of Medicare rates compared to commercial insurance.

Anesthesiologists get less 20% reimbursement on the dollar with Medicare compared to commercial.

The issue is there is no give or take with Medicare reimbursement for anesthesia services. It’s also a big fight.

So the no surprises billing act forces arbitration for anesthesia services to try to negotiate anesthesia services closer to Medicare rates and it’s simply not a sustainable business model.

Your facility you had the GI procedure likely sold out anyways. Most Gi centers are own by private equity or hospitals these days. The facility fee for Gi procedure is generally 2-3k. Gi fee is $500. Try asking your Gi facility center you had a scope to take 20% of that 2-3k. (So $500 facility fee)

Try asking Gi docs to take $100’for the scope.

We anesthesiologist would gladly take $80 for Gi scope to be in network than.

UHC would be laughing to the bank along with their shareholders.

Think next time you think about greed in medicine.
 
psycho-matic said:
You anesthesiologists griping about the no surprises act are fu**ing greedy. It's the right thing to do for the patient. When the patient chooses an in-network surgeon/proceduralist the patient has no control over whether their contracted anesthesia provider is in-network.

A few years ago, I needed a rather urgent EGD and my gi doc worked me in the next day. Everything was fine until UHC denied the CRNA because he was out of network. Contacted the billing officer and they said they were sorry, they thought their providers were with every UHC plan. Well not my plan, I guess.
Click to expand...

So you had a problem with the insurance company and an out of network nurse so that makes anesthesiologists greedy? Makes sense bro. I have no idea what plans are in or out of network with me and I'm not responsible for the nuances of every persons insurance plan. The fact that networks are even a thing is not my fault. Are you under the impression that decreased physician reimbursements will lead to decreased premiums and lower out of pocket payments rather than increased insurance company profits?

I want to be paid fairly for the stress of my daily work. Patients are getting sicker, procedures are becoming more intricate and everyone expects more and more. Why should I make less so that useless insurance company middle men can post hundreds of billions in profits? I do a case and make like $500, the surgeon makes $5000 and the facility makes $50,000. How am I the greedy one?

Pharmacy benefit managers are kicking back profits to themselves with bribery and overinflated charges, insurance companies are denying 30% of claims despite all the games they play with pre authorization and other nonsense and payors are constantly cutting physician reimbursement while premiums continue to rise. You should see the games insurance companies play such as how they offer higher rates for people doing certain things while decreasing rates for things that they don't do. For example they will tell a pcp that they will increase payment for smoking cessation in exchange for decreasing reimbursement for their blocks. Pcp won't care because they don't do those procedures. When they present numbers for average reimbursement for blocks it looks lower than it should be and this affects the people that do blocks both in actual reimbursement and in arbitration.

Now insurers are starting to stop paying for things arbitrarily (asa class, blocks) while putting unnecessary charting burdens for other things (imaging pictures for ultrasound or lines) and even tried to stop paying for our time unilaterally. This is all at a time when anesthesia availability is at a premium and locums are minting money.
 
I might put it differently. I would guess most anesthesiologists don’t think the system of surprise bills is great for patients. At the same time, the fix for this problem made it impossible for anesthesiologists and other physicians to have any leverage with insurance companies in the negotiations for payment, in general. This is what we object to.
 
psycho-matic said:
You anesthesiologists griping about the no surprises act are fu**ing greedy. It's the right thing to do for the patient. When the patient chooses an in-network surgeon/proceduralist the patient has no control over whether their contracted anesthesia provider is in-network.

A few years ago, I needed a rather urgent EGD and my gi doc worked me in the next day. Everything was fine until UHC denied the CRNA because he was out of network. Contacted the billing officer and they said they were sorry, they thought their providers were with every UHC plan. Well not my plan, I guess.
Click to expand...

Dude.

Virtually none of us have anything to do with billing. We don't get to pick which cases we do. We didn't choose your insurance plan. We didn't make you sick, bring you to the hospital, or decide you needed an urgent EGD.

(Incidentally, most of us hate GI, especially the inpatient add-ons, and especially especially the daily menu of urgent EGDs, most of which aren't actually urgent. I would be quite happy to never set foot in GI again. I'd rather do OB all day.)

Your gripe is with your insurance company.

You can get mad at us if you want, but you're just being duped by the insurance company, who wants you to hate us and not them.
 
cchoukal said:
I might put it differently. I would guess most anesthesiologists don’t think the system of surprise bills is great for patients. At the same time, the fix for this problem made it impossible for anesthesiologists and other physicians to have any leverage with insurance companies in the negotiations for payment, in general. This is what we object to.
Click to expand...
The issue is we are (were) OVERPAID for commercial insurance and severely UNDERPAID for Medicare

Why has this 20 cents or less compensation on the dollar compensation for Medicare continued for decades

While my surgeons friends get 60/70 cents on the dollar with Medicare.

There is no give and take.

It’s ridiculous to get $800 for a 15-20 min Mac colonoscopy. Yes thats the physical check from Aetna. But $80 for Medicare for same Mac Medicare.
 
pgg said:
Dude.

Virtually none of us have anything to do with billing. We don't get to pick which cases we do. We didn't choose your insurance plan. We didn't make you sick, bring you to the hospital, or decide you needed an urgent EGD.

(Incidentally, most of us hate GI, especially the inpatient add-ons, and especially especially the daily menu of urgent EGDs, most of which aren't actually urgent. I would be quite happy to never set foot in GI again. I'd rather do OB all day.)

Your gripe is with your insurance company.

You can get mad at us if you want, but you're just being duped by the insurance company, who wants you to hate us and not them.
Click to expand...

Ever since I discovered I have control over the music in GI, it has transformed from being one of my least favorite locations to most favorite.
 
aneftp said:
Yes and no. It’s evil vs evil. Insurers and the AHA battling each other.

You don’t get it.

Facilities reimbursements (especially mega hospitals mergers) jack up insurance reimbursements for themselves. Look at any facilities reimbursements from mega hospitals. It’s huge

Add in the fact anesthesia is a huge money loser for Medicare reimbursement.

A surgeon will get reimburse 60-70% of Medicare rates compared to commercial insurance.

Anesthesiologists get less 20% reimbursement on the dollar with Medicare compared to commercial.

The issue is there is no give or take with Medicare reimbursement for anesthesia services. It’s also a big fight.

So the no surprises billing act forces arbitration for anesthesia services to try to negotiate anesthesia services closer to Medicare rates and it’s simply not a sustainable business model.

Your facility you had the GI procedure likely sold out anyways. Most Gi centers are own by private equity or hospitals these days. The facility fee for Gi procedure is generally 2-3k. Gi fee is $500. Try asking your Gi facility center you had a scope to take 20% of that 2-3k. (So $500 facility fee)

Try asking Gi docs to take $100’for the scope.

We anesthesiologist would gladly take $80 for Gi scope to be in network than.

UHC would be laughing to the bank along with their shareholders.

Think next time you think about greed in medicine.
Click to expand...

I appreciate your perspective and you're right about corporate greed in medicine. But fix the system. It's not the patient's problem. The end doesn't justify the means.
 
GassYous said:
So you had a problem with the insurance company and an out of network nurse so that makes anesthesiologists greedy? Makes sense bro. I have no idea what plans are in or out of network with me and I'm not responsible for the nuances of every persons insurance plan. The fact that networks are even a thing is not my fault. Are you under the impression that decreased physician reimbursements will lead to decreased premiums and lower out of pocket payments rather than increased insurance company profits?

I want to be paid fairly for the stress of my daily work. Patients are getting sicker, procedures are becoming more intricate and everyone expects more and more. Why should I make less so that useless insurance company middle men can post hundreds of billions in profits? I do a case and make like $500, the surgeon makes $5000 and the facility makes $50,000. How am I the greedy one?

Pharmacy benefit managers are kicking back profits to themselves with bribery and overinflated charges, insurance companies are denying 30% of claims despite all the games they play with pre authorization and other nonsense and payors are constantly cutting physician reimbursement while premiums continue to rise. You should see the games insurance companies play such as how they offer higher rates for people doing certain things while decreasing rates for things that they don't do. For example they will tell a pcp that they will increase payment for smoking cessation in exchange for decreasing reimbursement for their blocks. Pcp won't care because they don't do those procedures. When they present numbers for average reimbursement for blocks it looks lower than it should be and this affects the people that do blocks both in actual reimbursement and in arbitration.

Now insurers are starting to stop paying for things arbitrarily (asa class, blocks) while putting unnecessary charting burdens for other things (imaging pictures for ultrasound or lines) and even tried to stop paying for our time unilaterally. This is all at a time when anesthesia availability is at a premium and locums are minting money.
Click to expand...

No, not because of my experience. Because of hearing you all complain about the no surprise billing act. Maybe "greed" isn't the right word, but the attitude I read here is that you generally are OK with screwing the patient over with OON billing.
 
pgg said:
Dude.

Virtually none of us have anything to do with billing. We don't get to pick which cases we do. We didn't choose your insurance plan. We didn't make you sick, bring you to the hospital, or decide you needed an urgent EGD.

(Incidentally, most of us hate GI, especially the inpatient add-ons, and especially especially the daily menu of urgent EGDs, most of which aren't actually urgent. I would be quite happy to never set foot in GI again. I'd rather do OB all day.)

Your gripe is with your insurance company.

You can get mad at us if you want, but you're just being duped by the insurance company, who wants you to hate us and not them.
Click to expand...

Not mad at any of you for the my insurance company issue. It was an example of how surprise out of network billing hurts the patient. My beef is that you all seem OK with it hurting the patient if it means your income doesn't decrease. The system needs to be fixed.
 
psycho-matic said:
I appreciate your perspective and you're right about corporate greed in medicine. But fix the system. It's not the patient's problem. The end doesn't justify the means.
Click to expand...
I posted a few months ago my friend was having a shoulder scope and anesthesia was out of network. He ended up paying cash for anesthesia to get the scope done. It’s a pain yes. We get it.

Coincidentally my wife had an egd a few years ago. I worked with the GI doc. We go to nba games together. Good GI doc. He owned the GI center. So waived all facility fees and his fees. He directed third party anesthesia to waive their fees also. So no anesthesia bill.

But. Still i got hit with $500 path bill. So only much he could do.
 
psycho-matic said:
Not mad at any of you for the my insurance company issue. It was an example of how surprise out of network billing hurts the patient. My beef is that you all seem OK with it hurting the patient if it means your income doesn't decrease. The system needs to be fixed.
Click to expand...

I'm not OK with surprise billing. I'm also not OK with being paid less than I should as a physician. How can we reconcile this? The ones in control are the insurance companies and hospitals that negotiate the innetwork and out of network contracts. So don't blame the boots on the ground doing actual patient care. Blame the executives wearing $10k suits who make medicine into big business.
 
psycho-matic said:
You anesthesiologists griping about the no surprises act are fu**ing greedy. It's the right thing to do for the patient. When the patient chooses an in-network surgeon/proceduralist the patient has no control over whether their contracted anesthesia provider is in-network.

A few years ago, I needed a rather urgent EGD and my gi doc worked me in the next day. Everything was fine until UHC denied the CRNA because he was out of network. Contacted the billing officer and they said they were sorry, they thought their providers were with every UHC plan. Well not my plan, I guess.
Click to expand...
😢 Cry!
 
psycho-matic said:
A few years ago, I needed a rather urgent EGD and my gi doc worked me in the next day. Everything was fine until UHC denied the CRNA because he was out of network. Contacted the billing officer and they said they were sorry, they thought their providers were with every UHC plan. Well not my plan, I guess.
Click to expand...
It sounds like you may have a lower tier or marketplace plan

I come across this a lot on the clinic side as a pain physician. I’m in network with the major players but they’ll have these random off-shoot plans that are their cheapest offerings. They trick patients into thinking they will have lots of access to physicians. I can’t even get onto those plans if I wanted to because it’s by design - the plan is cheaper because the network is limited.

Then patients get mad at me because they think I did it on purpose.
 
Agast said:
It sounds like you may have a lower tier or marketplace plan

I come across this a lot on the clinic side as a pain physician. I’m in network with the major players but they’ll have these random off-shoot plans that are their cheapest offerings. They trick patients into thinking they will have lots of access to physicians. I can’t even get onto those plans if I wanted to because it’s by design - the plan is cheaper because the network is limited.

Then patients get mad at me because they think I did it on purpose.
Click to expand...

It's an excellent plan, UHC Student Resources. I see a lot of specialists, have had several surgeries in multiple states, never had a single issue. Also never had a single procedure, surgery or imaging pre-auth denied. The only medication ever denied was Zepound. The stories about UHC denials on the news lately, while I'm sure it occurs, I never experienced that.

When I looked into the provider, he was not in-network with any UHC plan. At the time, the gastroenterology group had formally separated from the multi-specialty clinic they had been part of for decades but had not yet relocated. The group was still using the clinic's procedure facility, which were also used by pulm to do bronchs. Because the CRNA wasn't employed by the group, it's possible they had the wrong information about all anesthesia being credentialed with UHC.

The group relocated to a new facility they built with their own CRNAs and I've never had an issue. The weird thing is they no longer covered inpatient when they moved. The hospital hired GI hospitalists. Weird concept.

I am with a different insurance company this year, but not because of network coverage.
 
psycho-matic said:
It's an excellent plan, UHC Student Resources. I see a lot of specialists, have had several surgeries in multiple states, never had a single issue. Also never had a single procedure, surgery or imaging pre-auth denied. The only medication ever denied was Zepound. The stories about UHC denials on the news lately, while I'm sure it occurs, I never experienced that.

When I looked into the provider, he was not in-network with any UHC plan. At the time, the gastroenterology group had formally separated from the multi-specialty clinic they had been part of for decades but had not yet relocated. The group was still using the clinic's procedure facility, which were also used by pulm to do bronchs. Because the CRNA wasn't employed by the group, it's possible they had the wrong information about all anesthesia being credentialed with UHC.

The group relocated to a new facility they built with their own CRNAs and I've never had an issue. The weird thing is they no longer covered inpatient when they moved. The hospital hired GI hospitalists. Weird concept.

I am with a different insurance company this year, but not because of network coverage.
Click to expand...
If you want to get upset with someone start with your GI group. Sounds like they bolted for a more lucrative setup (greed?) and didn’t dot their i’s and cross their t’s on the way out.
 
psycho-matic said:
It's an excellent plan, UHC Student Resources. I see a lot of specialists, have had several surgeries in multiple states, never had a single issue. Also never had a single procedure, surgery or imaging pre-auth denied. The only medication ever denied was Zepound. The stories about UHC denials on the news lately, while I'm sure it occurs, I never experienced that.

When I looked into the provider, he was not in-network with any UHC plan. At the time, the gastroenterology group had formally separated from the multi-specialty clinic they had been part of for decades but had not yet relocated. The group was still using the clinic's procedure facility, which were also used by pulm to do bronchs. Because the CRNA wasn't employed by the group, it's possible they had the wrong information about all anesthesia being credentialed with UHC.

The group relocated to a new facility they built with their own CRNAs and I've never had an issue. The weird thing is they no longer covered inpatient when they moved. The hospital hired GI hospitalists. Weird concept.

I am with a different insurance company this year, but not because of network coverage.
Click to expand...
Gi inpatient coverage are money losers. Why would you find it interesting they don’t cover inpatient.
 
aneftp said:
Gi inpatient coverage are money losers. Why would you find it interesting they don’t cover inpatient.
Click to expand...

Because they had before for decades. It's the GI hospitalist I find interesting..
 
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