“Commercial Insurance Isn’t in the Health Care Business. It’s in the Financial Business.”

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Katherine Eban, Vanity Fair 12/12/24: Doctors Seethe Over Insurance Companies’ “Out of Control” Tactics

A recent Vanity Fair Article echoed some of the problems that our group has experienced with insurance companies.

An excerpt:

While no one can seriously justify the decision to gun down a father of two to make a political point, Americans seem to agree on one thing: Something does need to be done about the country’s broken health insurance system.

The brutal slaying, and the frenzied manhunt that followed, have exposed widespread frustration with a system of for-profit health insurance that many Americans feel is actually killing them, one delayed-or-denied health insurance claim at a time. And doctors are as fed up as their patients…

Struggling with the seemingly arbitrary policies and undermarket reimbursements offered by UnitedHealth Group and other insurers, doctors feel trapped in a zero-sum game that has robbed them of their clinical independence.

Four companies, known collectively as BUCA—Blue Cross and Blue Shield, UnitedHealth, Cigna, and Aetna—have become so powerful that “when doctors try to negotiate, they have to take whatever that carrier gives them,” says Ron Howrigon, a health care consultant who represents doctors in their dealings with insurers…

Amid this anger, UnitedHealth stands out for its sheer size, its aggressive moves to vertically integrate healthcare, and its expansive denial of claims, say health care experts and doctors. Headquartered in Minnetonka, Minnesota, it is a behemoth that took in more than $370 billion last year, making it America’s fourth-largest corporation by revenue. It insures more than 26 million Americans. More than one tenth of US doctors are either employed by or affiliated with the UnitedHealth subsidiary Optum Health…

Doctors in independent practice groups describe strong-arm tactics by the company—suddenly pushing them out of network, slashing their reimbursements, and stranding their patients with almost no notice. “Their interest is in killing private practice physicians,” says a North Carolina anesthesiologist…

The travails of Rheumatology Associates, P.C., the largest private rheumatology practice in Indiana, is a case in point. UnitedHealth offered the doctors in the group such paltry reimbursements that negotiations on a new contract ground to a halt…The group met with the Indiana attorney general’s office…

The company’s conduct was often nightmarish, even for patients in network. “Even when we get approvals on their letterhead, they would turn around, deny claims, and say they were approved incorrectly.”…

“They have so much power, they are out of control. They believe they are untouchable.”

My take: In the article, a health policy physician states the following: “Commercial Insurance Isn’t in the Health Care Business. It’s in the Financial Business.”

Our group is currently out of network with UnitedHealth. We negotiated with them for more than two years and offered them rates that were as good or better than all of the other commercial insurers. Their claims about trying to negotiate rates that are “affordable for consumers and providers” are misleading. In our case, they are making their insured patients pay much more by forcing them to see other providers at an academic center with much higher costs, less availability, and longer travel distances. They don’t care about forcing patients, who have had long-standing relationships, to find new doctors or the inconvenience and cost to patient families. Their aim is to leverage their consolidation of coverage to force smaller groups to accept lower reimbursements. Over time, this will lead to even fewer options for patients.

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