It all started when…
When Nicole Salvato opened her mailbox last month, she got some jaw-dropping news: Her mother’s insurance company, UnitedHealthcare, had returned her premium payment and was dropping the 80-year-old from its Medicare Advantage plan. In fact, after 25 years of membership her elderly mother won't be covered at all next month. “I couldn't believe it. I just couldn't believe it,” Salvato said.
What's easier to believe for those affected by the cuts is that because Obamacare makes it harder for insurers to cut patients from their rolls, they're beginning to play dirty -- misinforming high cost patients, preemptively dropping them for spurious reasons, and hoping expensive patients move to other providers or reenroll at the higher rate the following year.
The Salvato’s called, wrote letters and escalated to the legal department. At every step they were given the run around. Repeatedly put off, regularly given incorrect information and otherwise ignored, until they were eventually told “There is no appeal process.” This was just another in the long list of false statements and prevarications from United representatives who are actually required to explain the appeal process in United’s Administrative Guide. “It felt like they were trying to wear us down.” Sally’s son said.
United’s move to unceremoniously dump the old woman from United's Medicare Advantage plan came with little or no explanation. This left Nicole Salvato and her husband, Daniel, facing a tough choice: Do they continue paying out of pocket for the necessary medical care for their mother, or bring their mother to live with them and try to care for Sally themselves?
“United Health Care has been Sally’s provider for 25 years. She’s always paid on time and never used their service extensively, and now that she’s sicker, and more expensive they drop her like hot potatoes. It’s disgusting.” Salvato said “It’s just been a nightmere. What do old, sick people do when they have no family to help them and nowhere to go? No wonder people are ending up on the street.”
So they escalated the issues within United. And were repeatedly told to reenroll in January, which would cost significantly more. Of the eleven prescriptions that United covered, half of them are either going to cost more or won’t be covered at all under her new enrollment plan.
“It’s just been a nightmare. What do old, sick people do when they have no family to help them and nowhere to go?
No wonder people are ending up on the street!”
This isn't the first time UnitedHeath came under scrutiny for questionable business practices. They have been involved in multiple federal suits in recent years. The suit, filed by United Healthcare sales agents in Wisconsin, accuses the giant insurer of keeping a “dual set of books” to hide serious complaints about its services and of being “intentionally ineffective” at investigating misconduct by its staff. Last year a federal judge unsealed the lawsuit, first filed in October 2016.
“Employees testify UnitedHealthcare policies are “intentionally ineffective.”
According to the New York Times, United Healthcare, was also sued by the Department of Justice (DOJ) for fraud. According to whistle blower, Benjamin Poehling, a former finance director for UnitedHealthcare Medicare and Retirement says “UnitedHealth Overbilled Medicare by Billions.”
“UnitedHealth Defrauded Billions.”
Mr. Poehling’s says UnitedHealth uses sophisticated data-mining programs to look for expensive enrollees and get more from Medicare or drop them from enrollment. As a finance director in UnitedHealth’s Medicare & Retirement unit, he was expected to monitor the revenue increases that resulted. One anonymous source at UHC said “they’re cooking the books and old people are ending up on the street.”
“They’re cooking the books and old people are ending up on the street.”
United spent $400 million to settle class action lawsuit allegations brought by Cuomo and the American Medical Association that it rigged payments.
According to CNN, doctors think United is trimming high cost customers from its plans by dropping doctors as well, in hopes that the patients will move to another provider. Dr. Mieczkowski said “Let those high-cost patients move out of the UnitedHealthcare Medicare Advantage plan over to Anthem or Humana and let those poor suckers, so to speak, pick up the cost,” Mieczkowski said.
In Ohio, where Mieczkowski practices outside Dayton, hundreds of doctors and thousands of patients have been affected by United's cuts. And in Connecticut, United cut about 20% of its doctors, according to the state medical society. The American Medical Association says United and other insurers have taken similar action in at least a dozen states.
“These patients costs a lot,” said Todd Baker of the Ohio State Medical Association. “And United is going to those patients' doctors and dropping them and therefore getting rid of the patient.”
“Washington can't cut and tax the Medicare Advantage program this much and not expect seniors in the program to be harmed. And that's exactly what we're starting to see,” said Robert Zirkelbach of America's Health Insurance Plans.
Do these legal victories marks the end of that flawed system? According to a press release on the Attorney General’s website, Cuomo said: “For the past ten years, American patients have suffered from unfair reimbursements for critical medical services due to a conflict - ridden system that has been owned, operated, and manipulated by the health insurance industry. This agreement marks the end of that flawed system.”
However there is no indication United’s Bad Faith Insurance Practice have stopped. “This is just the beginning. As more and more of these cuts go into effect over the next several years, seniors are going to face even higher premiums, higher out-of-pocket costs for services and fewer health care choices.” said Zirkelbach.
Obviously United Healthcare is already seeing the impact to their reputation. In one post by Insurance Dodo “6 Reasons Why United Healthcare Sucks” he blogs that consumers have started an independent page to post complaints (UnitedHealthCareComplaints.com). There are also several additional independent sites that have United Healthcare Complaints Boards: Consumer Affairs, Pissed Consumer, My 3 Cents, Glass Door – Employee Complaints! Insurance Dodo reports that 85% of UnitedHealthcare reviews on Consumer Affairs are one Star (lowest satisfaction rating) and 14 percent are two stars. Out of 109 ratings only one rating is a five star rating.
These issues are current but they are not new, and UnitedHealthcare seems to have no intention of changing. Indeed the very month the Salvato’s were being dumped, United was on CNBC announcing dumping ER doctors next.
And even though the Salvato’s are currently able to cover their mom’s expenses and not lose the family farm, what is the human cost of these sort of unethical business practices?
Salvato says “We’re not going to take this lying down. We’re not walking away from all of the people that have UnitedHealthcare insurance and have no-one to help them, no-one to advocate for them, and that's hard," she said. "That's hard.”