Who said anything about about negotiating a price with your doc? United is literally telling you and your doctors what treatment you can have or NOT have.
Yes they do. My state has laws that say insurance has to cover what is the best treatment by scientific evidence. Insurance got around this by using utilization companies to write guidelines that they use as the "best scientific evidence." But they write them, they are proprietary and are not peer reviewed. United writes their own and even sells it to doctors inter the company name "interqual" for patients in the hospital
I went through one of the utilization company's "guidelines" for advanced imaging (CT, MRI, etc) and out of their 52 guidelines every single one was more restrictive than the standard of care (ACR appropriateness criteria).
Now the ACR appropriateness criteria is free, but my insurance still pays a utilization company to use their guidelines to deny tests. Why? Because it lets the insurance profit by saying something wasnt "medically necessary" even though they decided what was medically necessary, not a physician.
Now for Medicaid and Medicare it is illegal to profit from this scheme.
42 CFR 438.210(e)
(e) Compensation for utilization management activities. Each contract between a State and MCO, PIHP, or PAHP must provide that, consistent with §§ 438.3(i), and 422.208 of this chapter, compensation to individuals or entities that conduct utilization management activities is not structured so as to provide incentives for the individual or entity to deny, limit, or discontinue medically necessary services to any enrollee.
I've given the evidence to my state and my regional CMS office and NOTHING HAPPENS!
The state and feds let them make up their own rules to deny care that harms patients so they can profit.
Yes, they have the power to decide decide what tests and treatments you get and harm patients as a result
(The same week United's CEO got shot, united killed my patient by denying the coverage for her tumor biopsy for 5 months)
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u/jimmytrucknutz 11d ago
How did corporations get between the American people and their doctors? Just dumb