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The UnitedHealthcare Shooting Was Inevitable

  
Via:  John Russell  •  one month ago  •  44 comments

By:   Sarah Jones (Intelligencer)

The UnitedHealthcare Shooting Was Inevitable
America's political system is breaking down. Now, in the case of the UnitedHealthcare CEO, it has killed.

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Christopher McNaughton needed care for his ulcerative colitis, which had already caused him to develop arthritis, diarrhea, fatigue, and blood clots that could kill him. The disease was one problem; his insurance company, UnitedHealthcare, soon proved to be another. As ProPublica reported in 2023, medical bills cost McNaughton nearly $2 million a year, and UnitedHealthcare had flagged his case for review as a "high dollar account." In one recorded phone call, a nurse for United told a colleague that a doctor under contract with the company had concluded a drug cocktail that had "had brought McNaughton's disease under control" was not medically necessary. "I knew that was coming," said the colleague with a laugh, later complaining that McNaughton's mother was "throwing tantrums" in calls with United.

Had McNaughton's family not responded with a lawsuit, we might not know the extent of UnitedHealthcare's obstinance. His case is unusual in only one respect: He fought back. As ProPublica noted at the time, insurers reject about 1 in 7 claims for treatment, but according to one study, Americans appeal only 0.1 percent of the findings. Millions of people know what it's like for an insurance company to deny care. Millions of people have reason to be angry, even furious, with the insurers who control so much of their lives. The killing of UnitedHealthcare CEO Brian Thompson ripped the wound open. To some, the anonymous shooter is more folk hero than murderer.

As one popular post on X put it, "Today, we mourn the death of United Healthcare CEO Brian Thompson, gunned down…. wait, I'm sorry — today we mourn the deaths of the 68,000 Americans who needlessly die each year so that insurance company execs like Brian Thompson can become multimillionaires." One woman who'd cared for her cancer-stricken mother toldNew York that she felt "a little surge of Schadenfreude" at the news of Thompson's death. Though the shooter wrote the words "delay," "deny," and "depose" on his shell casings, we still don't know his exact motivations. It's obvious, however, that he meant to send a public message — and some appear open to it.

Cases like McNaughton's help explain the rage so many feel. Sarah Palin once warned the ACA would usher in "death panels" across America. What made her so laughable wasn't the fearmongering but the fact that death panels were already here. They are insurance companies. Life has improved since the ACA became law, and Medicaid expansion alone has likely saved many lives, but even the insurance-marketplace plans can cost hundreds of dollars a month. Still, according to the Commonwealth Fund, "the U.S. has the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates" of any high-income nation. (In November, ProPublica ran another story about UnitedHealthcare, this time on its "playbook" for limiting mental-health-care coverage.)

To deny a person care is to abandon them. They will suffer, and they may even die a preventable death, but an insurance company will save money, and that's the American way. Hidden within that "lack of sympathy" over Thompson's demise is a note of surprise. We are used to a level of unnecessary and unnatural death in this country, a burden typically borne by the poor. The wealthy not only live longer than the poor; they often boast healthier years as they age. That phenomenon isn't unique to the U.S., but it's not hard to see why it would persist here or why few would openly grieve the killing of a health-insurance executive. An individual act of violence cannot solve an unjust system, but it is a symptom of social dysfunction that our decision-makers ignore at their peril. That system is not only unsustainable, it is already breaking down. It has killed, too.

In 1845, the writer Friedrich Engels accused English society of grave crimes against the working class. "When one individual inflicts bodily injury upon another such that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder," Engels wrote in The Condition of the Working Class in England. When a country deliberately subjects its proletariat to conditions that result in premature death, "its deed is murder just as surely as the deed of the single individual" — more specifically, a phenomenon that Engels called social murder. The offense can seem natural, he explained, since it is more "of omission than of commission."

UnitedHealthcare does not pull a trigger and shoot its victims in the street. Instead, they suffer and may die of cancer, or of heart disease, or of some other treatable condition. Yet insurance companies like it bear some guilt nonetheless. A 2023 survey by the American Medical Association found that 9 percent of physicians blamed prior authorization — the requirement that a health-insurance company approve a treatment or prescription — for at least one patient's disability or even death. Another ProPublica story documented the case of Forrest VanPatten, who died from complications of cancer after his insurance company refused to cover a treatment that could have extended his life. In reckoning with the murder of Brian Thompson, we must reckon, too, with its seeming inevitability: with all the choices that brought us here.

When democratic norms fail and justice feels unattainable, people will reach their limit. Some will file a lawsuit. Others will make jokes on social media. And in this country, overrun with guns and violence, a few will resort to deadlier means. Thompson's death was preventable, as so many American deaths are. Until our political class concludes that life is more valuable than profit, there will be blood — if not in the streets, then in our hospitals and homes. Something has to give, and soon.


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JohnRussell
Professor Principal
1  seeder  JohnRussell    one month ago

Se. John Fetterman specifically attacked this article on a twitter post. 

 
 
 
Right Down the Center
Masters Guide
1.1  Right Down the Center  replied to  JohnRussell @1    one month ago

Good for him.  A democrat with empathy and common sense is hard to find.   I see him either changing parties willingly or getting kicked out of the dem party. 

 
 
 
Greg Jones
Professor Participates
1.2  Greg Jones  replied to  JohnRussell @1    one month ago

It's completely understandable why he would do so.

 
 
 
Buzz of the Orient
Professor Expert
1.3  Buzz of the Orient  replied to  JohnRussell @1    one month ago

This wasn't just a shooting, it was an assassination.  Only in America, among civilized nations, would an assassination be considered "inevitable".  Have there not been enough assassinations and enough attempts to do so to establish that as a fact. 

 
 
 
goose is back
Junior Participates
1.3.1  goose is back  replied to  Buzz of the Orient @1.3    one month ago
Only in America, among civilized nations, would an assassination be considered "inevitable". 

Consider the source before making that claim.  

 
 
 
Buzz of the Orient
Professor Expert
1.3.2  Buzz of the Orient  replied to  goose is back @1.3.1    one month ago

The source has nothing to do with my personal feelings about the number of assassinations and assassination attempts that have happened in America ever since Lincoln.  IMO the murder of John Lennon was as much of an assassination as any.

 
 
 
JohnRussell
Professor Principal
2  seeder  JohnRussell    one month ago

In the long long run we could say everything is inevitable. 

But here it is , now, that someone killed a health care company CEO.  Is it right or wrong for people to "rejoice"?   I wouldnt do it, but it doesnt bother me that people are "happy" one of these guys got some karma. If nothing ever happens to jolt the status quo it will continue on and on and on. 

 
 
 
Right Down the Center
Masters Guide
2.1  Right Down the Center  replied to  JohnRussell @2    one month ago
Is it right or wrong for people to "rejoice"? 

Yes, period.  

 
 
 
JohnRussell
Professor Principal
2.1.1  seeder  JohnRussell  replied to  Right Down the Center @2.1    one month ago
A democrat with empathy and common sense is hard to find.

According to the article 1 out of every 7 requests for treatment are denied by the insurance company.  Does it surprise you that some people would wish ill on the people who preside over those decisions? 

We may not like it, but millions of people have legitimate grievances about health care and what happened to this CEO is in fact inevitable. 

 
 
 
Right Down the Center
Masters Guide
2.1.2  Right Down the Center  replied to  JohnRussell @2.1.1    one month ago
According to the article 1 out of every 7 requests for treatment are denied by the insurance company.  Does it surprise you that some people would wish ill on the people who preside over those decisions? 

It does not surprise me because nothing surprises me.  That does not make condoning or celebrating murder  right.  It is not a justification.  If everyone that had a grievance about a decision made (a grievance they feel is valid) condoned murder America would surely degrade into anarchy.  

We may not like it, but millions of people have legitimate grievances about health care and what happened to this CEO is in fact inevitable. 

Millions of people have what they believe are legitimate grievances against supreme court justices for ruling against something they believe (maybe abortion).  Should it be open season on them?

Trump and others may feel they have a grievance against a certain prosecutor.  Should he be taken out?

Any condoning or celebrating someone getting murdered is just trying to normalize and rationalize the violence.

Is that what we really want as a society?

 
 
 
Sean Treacy
Professor Principal
2.1.3  Sean Treacy  replied to  JohnRussell @2.1.1    one month ago
ording to the article 1 out of every 7 requests for treatment are denied by the insurance compan

DO you imagine there  is a health care fairy that exists that will magically grant everyone unlimited, free health care at their convenience? Because if you want to shoot insurance executives for denying requests for coverage, I'm sure you will be much happier when its government bureaucrats denying even they ability to get treatment. 

 
 
 
Snuffy
Professor Participates
2.1.4  Snuffy  replied to  JohnRussell @2.1.1    one month ago

We may not like it, but millions of people have legitimate grievances about health care and what happened to this CEO is in fact inevitable. 

69% of Americans believe in Angels and 21% of Americans believe in magic and/or witchcraft. Just because a lot of people believe in something doesn't necessarily make it true or right.
It's ok for people to be upset over a negative experience but that does not give them the right to take such an action as murder. Plan and simple, people need to grow up and be responsible for themselves rather than continue to blame someone else for their plight in life.
 
 
 
JohnRussell
Professor Principal
2.1.5  seeder  JohnRussell  replied to  Snuffy @2.1.4    one month ago
Plan and simple, people need to grow up and be responsible for themselves rather than continue to blame someone else for their plight in life.

People cannot be "responsible" for their own health care. You could say they could take better care of themselves so they dont develop cancer or heart disease but we live in a consumer culture that happily sells people food that will eventually make many of them extremely ill.  Watch a cooking show, they put salt in everything , they put sugar in every baking recipie, they promote foods that have a lot of fat, and processed foods, and inevitably premature serious diseases and conditions will happen to almost every single American family. From the corporate standpoint a lot of this occurs just to make money. 

Most people cannot afford medical bills of tens of thousands of dollars no matter how much they might want to be "responsible" for themselves. 

 
 
 
Right Down the Center
Masters Guide
2.1.6  Right Down the Center  replied to  Sean Treacy @2.1.3    one month ago
DO you imagine there  is a health care fairy that exists that will magically grant everyone unlimited, free health care at their convenience? 

There could be if only the rich would pay their fair share. S/. And if they don't we can just say murdering them is inevitable and take their money. S/

America is degrading quicker than I ever would have believed. 

 
 
 
Snuffy
Professor Participates
2.1.7  Snuffy  replied to  JohnRussell @2.1.5    one month ago

Way to miss the point. People need to be responsible for their actions and reactions. You wanted to point out that people have legitimate grievances about health care and I responded that people need to be responsible for their reactions. Murder is wrong and for someone to state that this murder was inevitable is just as wrong. 

 
 
 
JohnRussell
Professor Principal
2.1.8  seeder  JohnRussell  replied to  Snuffy @2.1.7    one month ago
Plan and simple, people need to grow up and be responsible for themselves rather than continue to blame someone else for their plight in life.

You should construct your sentences better then.  Your sentence reads as if people "cheering" for the CEO's death are responsible for their own poor health. 

 
 
 
Snuffy
Professor Participates
2.1.9  Snuffy  replied to  JohnRussell @2.1.8    one month ago

Can't rebut what I said so you have to turn to be the grammar police? Very weak. Maybe don't be a cheerleader for murder, ya know.

 
 
 
George
Senior Expert
2.1.10  George  replied to  JohnRussell @2.1.8    one month ago

If those people abused drugs, alcohol or tobacco, if they are obese they are responsible to a degree for their health.

 
 
 
afrayedknot
Senior Quiet
2.2  afrayedknot  replied to  JohnRussell @2    one month ago

“If nothing ever happens to jolt the status quo it will continue on and on and on.”

Cold blooded murder is never, ever an acceptable response, lest we devolve into a nightmare scenario predicated on excusing violence to address legitimate concerns. 

 
 
 
JohnRussell
Professor Principal
2.2.1  seeder  JohnRussell  replied to  afrayedknot @2.2    one month ago

History is replete with instances of violence used to enact societal and geopolitical change and it was not always for the worse. 

 
 
 
Sean Treacy
Professor Principal
3  Sean Treacy    one month ago

Wow.  It hasn't taken long for large swaths of the  left to become full on terrorism supporters. Cheerleading for the Trump shooting, Hamas, and now the public execution of a businessman because they don't like his industry.  

Never, ever pay attention when those people whine about norms, or Trump.  

 
 
 
JohnRussell
Professor Principal
3.1  seeder  JohnRussell  replied to  Sean Treacy @3    one month ago

Trump has done more , personally, to break down social norms than any individual in our lifetimes , and maybe in the nation's history. 

Millions of people said if he was convicted of a felony they wouldnt vote for him and then did so anyway. 

Society is breaking down, and the health care insurance industry has its fingers well into that pie. 

 
 
 
Sean Treacy
Professor Principal
3.1.1  Sean Treacy  replied to  JohnRussell @3.1    one month ago
Society is breaking down

Yes, an attempt to normalize the murder of anyone who does something that strikes someone else as unfair will lead to the end of civil society.  

 
 
 
JohnRussell
Professor Principal
3.1.2  seeder  JohnRussell  replied to  Sean Treacy @3.1.1    one month ago

If the people who dont have the power never "revolted" against those that do we would still have a world totally consisting of countries with authoritarian hereditary monarchies. 

You are Irish. Did the Irish have the right to overthrow Great Britain's rule of their country? 

 
 
 
Sean Treacy
Professor Principal
3.1.3  Sean Treacy  replied to  JohnRussell @3.1.2    one month ago
f the people who dont have the power never "revolted" against those that do we w

Which lane are you in? The defender of norms, the rule of law  and democracy or the radical revolutionary who wants civil war?  You can't be both. 

 
 
 
JohnRussell
Professor Principal
3.1.4  seeder  JohnRussell  replied to  Sean Treacy @3.1.3    one month ago

I dont consider health care insurance companies rejecting 15% of all claims for treatment to be a worthwhile norm. 

 
 
 
JohnRussell
Professor Principal
3.1.5  seeder  JohnRussell  replied to  Sean Treacy @3.1.3    one month ago

I think Trump said something to effect today that he will have a new health care plan for America if something comes along. He has no intention of trying to change anything for the better, he just wants to bullshit about it. 

 
 
 
Sean Treacy
Professor Principal
3.1.6  Sean Treacy  replied to  JohnRussell @3.1.4    one month ago
t consider health care insurance companies rejecting 15% of all claims for treatment to be a worthwhile norm.

So when you personally don't like something violence is justified. 

Somebody thinks taxes are too high? Shoot the tax collector. 

Don't like abortion?  Shoot the abortionist.

Don't like DEI impacting school admisisons? Shoot the admissions officer.  

This is how you want society to operate? 

 
 
 
Right Down the Center
Masters Guide
3.1.7  Right Down the Center  replied to  JohnRussell @3.1.4    one month ago

Advantage plans are supposed to cover what Medicare covers.  Sounds like the issue is more with the government.   

 
 
 
JohnRussell
Professor Principal
3.1.8  seeder  JohnRussell  replied to  Sean Treacy @3.1.6    one month ago

I would call for a national in the streets protest against the fact we have no national health care, and not violence, but I dont get to tell everyone what to do. 

Trump is going to have the most corrupt administration in the history of this country, are you ok with that? 

 
 
 
JohnRussell
Professor Principal
3.1.9  seeder  JohnRussell  replied to  Right Down the Center @3.1.7    one month ago

There are pluses and minuses with Medicare Adbantage. It does not equate with a national health care system like other countries have. 

 
 
 
Right Down the Center
Masters Guide
3.1.10  Right Down the Center  replied to  JohnRussell @3.1.9    one month ago

So maybe if enough healthcare executives get murdered we will go for that. Sounds like a plan. S/

 
 
 
sandy-2021492
Professor Expert
3.1.11  sandy-2021492  replied to  Right Down the Center @3.1.7    one month ago

What ends up happening is that the insurance company who now has the patient's Medicare funds as premiums can now deny care the same as they would for a non-Medicare patient.

My employee's uncle had a cardiac valve replacement.  His Medicare Advantage plan (Humana, I think, but could be wrong) denied his cardiologist visit the following year.  Said it wasn't medically necessary.  Sure, part of his heart was replaced with post-factory parts, but that doesn't really require any followup, right?

 
 
 
Right Down the Center
Masters Guide
3.1.12  Right Down the Center  replied to  sandy-2021492 @3.1.11    one month ago
What ends up happening is that the insurance company who now has the patient's Medicare funds as premiums can now deny care the same as they would for a non-Medicare patient.

The insurance company is still supposed to cover whatever Medicare would cover, by law.

Said it wasn't medically necessary. 

Therein lies the rub.  Original Medicare uses the same wording, medically necessary.  That leaves it open to a wide interpretation.

Sure, part of his heart was replaced with post-factory parts, but that doesn't really require any follow-up, right?

I am not a doctor or have information regarding it so I have no clue.  Would it be nice?  Yep.  Is it medically necessary?  Don't know.  Look at definition of medically necessary:

Medical necessity is a legal doctrine that defines whether health care services are reasonable, necessary, and appropriate. It's based on evidence-based clinical standards of care.
Health insurance plans typically only provide benefits for medically necessary treatments and services.  
The insurance company a person is considering have what their definition of medically necessary is.  I suggest people look at it closely before signing on the dotted line.

 
 
 
Tacos!
Professor Guide
3.1.13  Tacos!  replied to  JohnRussell @3.1.8    one month ago
I would call for a national in the streets protest against the fact we have no national health care, and not violence

It would not make any difference to the people who are trying say you’re being pro-murder or pro-terrorism. Any protest can - and often is - characterized as somehow inappropriate if it’s protesting something they support politically.

I’m tired of hearing that it’s “the way they protested.” That is usually bullshit to deflect from whatever the protest was about. Contemporaries of Gandhi and MLK jr. criticized them for their inappropriate protests. The deflection never ends.

 
 
 
JohnRussell
Professor Principal
3.1.14  seeder  JohnRussell  replied to  sandy-2021492 @3.1.11    one month ago

I had heart valve replacement in Aug of '23. People that have this degree of heart issues need to see a cardiologist at least a couple times a year to monitor their progress, or lack of. 

Heart patients that have had a serious procedure also need an electrocardiogram twice a year for the same reason. I dont see any reason for the insurance company to say they dont need it. 

 
 
 
Sean Treacy
Professor Principal
3.1.15  Sean Treacy  replied to  Tacos! @3.1.13    one month ago
uld not make any difference to the people who are trying say you’re being pro-murder or pro-terrorism.

Lol. How ludicrous. 

Of course peaceful protesting  is okay. There's  all the difference in the world between protesting policy peacefully and shooting an executive in cold blood.   

of hearing that it’s “the way they protested.”

Right.  No one ever supports protesting peacefully and does not also support murdering people. It's impossible to draw a line between the two.  

 
 
 
sandy-2021492
Professor Expert
3.1.16  sandy-2021492  replied to  Right Down the Center @3.1.12    one month ago
supposed to

Operative words.

They're "supposed to".

They don't.

I am not a doctor or have information regarding it so I have no clue.

I don't think one needs to be a doctor to understand that somebody whose heart valve (valves are pretty important to pumps) became nonfunctional to the point of needing replacement via surgical means might require followup observation to ensure that the new valve, and the rest of the heart, which is generally damaged by the malfunctioning valve to some degree, are still functioning as normally as possible.  But perhaps I overestimate people in general.

 
 
 
Tacos!
Professor Guide
3.1.17  Tacos!  replied to  Sean Treacy @3.1.15    one month ago
There's  all the difference in the world between protesting policy peacefully and shooting an executive in cold blood. 

I certainly think so. But as I indicated, I see people complain about protests no matter how peaceful they might be. And the complaint is rarely about the policy. It's almost always about the method of protest.

Curiously, a lot of the people I see - rightly - condemning the murder of this CEO also endorse the violent events of January 6, 2021. They claim that the actions of the crowd that day were peaceful or - if they acknowledge the force and violence - justified.

At minimum, we are expected to agree or empathize with that crowd on their viewpoint. Somehow, for that event, agreement or empathy would not be an endorsement of violence.

That's the pattern I see.

What about the law? A lot of people point to the law as a clear definer of Right and Wrong. Well, murder is obviously illegal, but could potentially be pardoned. Certainly Trump has suggested he would pardon people convicted for their violence on January 6 (and, for that matter, in other situations). Guess that makes it all ok?

My overall point here is that whether you see an action of protest as right or wrong may depend a lot on your viewpoint on the issue being protested.

 
 
 
Sean Treacy
Professor Principal
3.1.18  Sean Treacy  replied to  sandy-2021492 @3.1.16    one month ago

[Removed, terms] [] of [] service[]

 
 
 
Right Down the Center
Masters Guide
3.1.19  Right Down the Center  replied to  sandy-2021492 @3.1.16    one month ago
They don't.

How many do not follow the law?  That does not mean how many were declined but how many are declined that should not have been based on the law and their own company definition of what is considered medically necessary.  There is a way to challenge the call against you.  There are even brokers that will represent you. 

I don't think one needs to be a doctor to understand that somebody whose heart valve (valves are pretty important to pumps) became nonfunctional to the point of needing replacement via surgical means might require followup observation to ensure that the new valve, and the rest of the heart, which is generally damaged by the malfunctioning valve to some degree, are still functioning as normally as possible.  But perhaps I overestimate people in general.

That is part of the problem.  People that think no qualifications or medical knowledge (other than an internet doctors degree) are necessary to determine what is medically necessary within the parameters of the of the insurance company documents.  And of course if someone does not like what their insurance company has to say they can always go to another.  How long would a company stay in business if everyone left them?

But perhaps I overestimate people in general.

Seems so.  People are not as smart or qualified to make certain decisions as they think they are.

 
 
 
Right Down the Center
Masters Guide
3.1.20  Right Down the Center  replied to  JohnRussell @3.1.4    one month ago
I dont consider health care insurance companies rejecting 15% of all claims for treatment to be a worthwhile norm. 

How many of that 15% are justified rejecting based on medically necessary definitions of the company?

 

 
 
 
sandy-2021492
Professor Expert
3.1.21  sandy-2021492  replied to  Right Down the Center @3.1.19    one month ago

At least one that I know of.  Visits with a cardiologist are reasonable, necessary, and appropriate for the patient I described.

  • The vast majority of requests that were appealed in 2022 were subsequently overturned: 83.2%. This number has also remained steady over the past few years.

...

According to the latest results from the  AMA’s annual nationwide survey  (PDF) of 1,000 practicing physicians about prior authorization, 94% of physicians reported that prior auth led to delays to patients’ access to necessary care, and 78% of   physicians reported   that the process can at least sometimes lead to patients abandoning their physicians’ recommended course of treatment.

On top of that, 24% of physicians reported that prior authorization has led to a serious adverse event for a patient in their care. Among the physicians the AMA surveyed, these shares said that prior authorization resulted in a serious or adverse event leading to:

  • A patient being hospitalized—19%.
  • A life-threatening event or requiring intervention to prevent permanent impairment or damage—13%.
  • A patient’s disability, permanent bodily damage, congenital anomaly, birth defect or death—7%.

So, yeah, it seems that they're initially denying care that their own appeals process agrees (eventually) is necessary, and denying care that was medically necessary, as evidenced by bad outcomes for the patients involved.

WHAT WE FOUND

Our case file reviews determined that MAOs sometimes delayed or denied Medicare Advantage beneficiaries' access to services, even though the requests met Medicare coverage rules. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules. Denied requests that meet Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care and can burden providers. Although some of the denials that we reviewed were ultimately reversed by the MAOs, avoidable delays and extra steps create friction in the program and may create an administrative burden for beneficiaries, providers, and MAOs. Examples of health care services involved in denials that met Medicare coverage rules included advanced imaging services (e.g., MRIs) and post-acute facility stays (e.g., inpatient rehabilitation).

Prior authorization requests. We found that, among the prior authorization requests that MAOs denied, 13 percent met Medicare coverage rules; in other words, these services likely would have been approved for these beneficiaries under original Medicare (also known as Medicare fee-for-service). We identified two common causes of these denials. First, MAOs used clinical criteria that are not contained in Medicare coverage rules (e.g., requiring an x-ray before approving more advanced imaging), which led them to deny requests for services that our physician reviewers determined were medically necessary. Although our review determined that the requests in these cases did meet Medicare coverage rules, CMS guidance is not sufficiently detailed to determine whether MAOs may deny authorization based on internal MAO clinical criteria that go beyond Medicare coverage rules.

Second, MAOs indicated that some prior authorization requests did not have enough documentation to support approval, yet our reviewers found that the existing beneficiary medical records were sufficient to support the medical necessity of the services.

Payment requests. We found that, among the payment requests that MAOs denied, 18 percent of the requests met Medicare coverage rules and MAO billing rules. Most of these payment denials in our sample were caused by human error during manual claims processing reviews (e.g., overlooking a document) and system processing errors (e.g., the MAO's system was not programmed or updated correctly).

We also found that MAOs reversed some of the denied prior authorization and payment requests that met Medicare coverage and MAO billing rules. Often the reversals occurred when a beneficiary or provider appealed or disputed the denial, and in some cases MAOs identified their own errors.

The government seems aware there's a problem.  Why are you so keen to deny it?

 
 
 
Tacos!
Professor Guide
4  Tacos!    one month ago

Saying the anger is understandable is not pro-murder. Neither is empathy for those who are so frustrated that they don’t know what else to do somehow advocating murder.

Further, all the self-righteous people saying murder is never the answer forget how many people through history they would support killing in the name of freedom or some other kind of justice.

The continuing far-right defense of our health care system is baffling. By every objective measure I have seen, our system ranks poorly compared to our peers, internationally. It is either ignorant, disingenuous or just cold-hearted to ignore the many poor health outcomes and pretend there is no situation in which an otherwise law-abiding person might be motivated to kill. It might not be legal, but it should be understandable.

 
 

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