It really takes some work to stand out as a truly awful human being, but some people are just up to the task. I present to you Victoria Kavanaugh and Dave Opperman:
n May 2021, a nurse at UnitedHealthcare called a colleague to share some welcome news about a problem the two had been grappling with for weeks.
United provided the health insurance plan for students at Penn State University. It was a large and potentially lucrative account: lots of young, healthy students paying premiums in, not too many huge medical reimbursements going out.
But one student was costing United a lot of money. Christopher McNaughton suffered from a crippling case of ulcerative colitis — an ailment that caused him to develop severe arthritis, debilitating diarrhea, numbing fatigue and life-threatening blood clots. His medical bills were running nearly $2 million a year.
United had flagged McNaughton’s case as a “high dollar account,” and the company was reviewing whether it needed to keep paying for the expensive cocktail of drugs crafted by a Mayo Clinic specialist that had brought McNaughton’s disease under control after he’d been through years of misery.
On the 2021 phone call, which was recorded by the company, nurse Victoria Kavanaugh told her colleague that a doctor contracted by United to review the case had concluded that McNaughton’s treatment was “not medically necessary.” Her colleague, Dave Opperman, reacted to the news with a long laugh.
“I knew that was coming,” said Opperman, who heads up a United subsidiary that brokered the health insurance contract between United and Penn State. “I did too,” Kavanaugh replied.
Opperman then complained about McNaughton’s mother, whom he referred to as “this woman,” for “screaming and yelling” and “throwing tantrums” during calls with United.
The pair agreed that any appeal of the United doctor’s denial of the treatment would be a waste of the family’s time and money.
“We’re still gonna say no,” Opperman said.
These people should be tarred and feathered. Imagine showing up every day to work and slaving away to make someone else’s life a living hell to save a few bucks for a corporation that would fire you at the drop of a hat and make 20 billion in profits last year. I hope they get rectal cancer and have their claims denied.
Insurance companies are not to be trusted.
Rebrand “single-payer” as “single-insurer.” Do it for medical and for auto.
The only role for insurance companies is utter disaster: your house burns down, you die, etc. For anything else — anything where there is any POSSIBLE dispute, no matter how farfetched — they’re gonna weasel until you actually DO die.
They’re worse than banks, and that’s saying something
(And as a corollary: who actually chooses to do that for a living? I mean, what kind of empty frozen wasteland of a soul is necessary even to contemplate it? Like, how many Kevin McCarthys ARE there?)
Case comes to trial…it’s the insurance company’s doctor vs the Mayo Clinic in the family’s suit against United Healthcare…especially because the insurance company will be the principal named defendant, the jury shouldn’t have much difficulty sussing out who’s the shill here. And so United Healthcare’s main tactic will be to insert as much delay in the legal process as possible. In the end, United will lose, but meanwhile they will have held onto several million $ for a few years longer than they would have had they honored the claim up-front.
What John said.
I have said it before here, for-profit healthcare is a crime.
Jacqueline Squid Onassis
Now that’s the UHC I know and love! I was happy to cost them over $100k during the 6 months I was their client.
john (not mccain)
May they become dependent upon the kindness of strangers just like them.
@cmorenc: sure, *IF* the family has the economic AND emotional means to pursue it, neither of which is at all assured. And this is exactly what the inscos count on — probably more the latter than the former, because there are attorneys who will take good cases on contingency, but the family has to have the mental reserves to see it through.
Inscos have evolved into the lowest of bottom-feeding scum. There is an economic need for risk-sharing, but they have turned it into little more than a con game. By and large, they are scum.
Assuming the victim was not forced into arbitration to get the coverage …
And now, for your Thursday night pick-me-up…
But I’ve been told that people in Canada and the UK have to wait many days to see a specialist sometime and that is definitely way worse than this, for sure, yes indeed.
It’s disturbing that someone would go into nursing when they apparently lack a soul.
This is why I’m glad CA universities moved all student policies onto the exchange. They can still target individuals, but the risk pool is so large that it wouldn’t be done in this manner.
My sister is a medical doctor. For years she has told me not to use United Healthcare. The reason? UH always turned down her patients’ requests for treatment. They are evil bastards.
Lord Fartdaddy (Formerly Mumphrey, Smedley Darlington Mingobat, et al.)
I truly wonder how people like this can live with themselves. I don’t get it. How do they keep getting up in the morning, telling their husbands, wives and children that they love them, and then go out and do shit like this. I can only guess that there’s something missing within them, something that makes the rest of us human. In a real sense, they aren’t fully or truly human. Former Guy and de Santis are examples of this on a grander scale, but these creatures are many, and they walk among us.
@Lord Fartdaddy (Formerly Mumphrey, Smedley Darlington Mingobat, et al.):
About 5% of the population are sociopaths. More than enough to staff up UH.
The Moar You Know
After my botched intestinal surgery in 2021, I started getting the treatment from UHC. Daily phone calls: “oh, we’re so concerned about you. What caused this?”
Not being stupid, knowing goddamn well they had a lawyer on the line, I told them to ask my doctor.
Then they started refusing to pay for imaging. They refused to pay for a home nurse. They refused to pay for a lot of things that could probably have helped.
I’ve not posted about this before because it’s a real bummer of a story, and more than one party shares some blame in the condition I’m left in, but while not technically crippled (I can still work and can still play three hour gigs, albeit in pain) I’m in constant non-trivial pain and likely will be for the rest of my life.
And every single goddamn claim I file for anything with them now gets fought. Doesn’t matter if it’s fucking aspirin. Every claim gets denied and has to be appealed.
I though Kaiser was bad but I may well go back to them. UHC is far, far worse. Those are the only two choices I’ve got
ETA: there were five surgeries in all. I’m sure I cost them well over 2 million bucks. Hope so, anyway.
@Martin: Sadly, there are indications that the segment of the population made up of sociopaths might be 27%.
@hueyplong: Won’t dispute.
if there’s a way to hold the insurance company’s ” evaluation doctors and nurses responsible for their bullshit denials it needs to be done….they are causing immense pain, suffering and death….also the CEOs and board members…
@hueyplong: @Martin: the Crazification Factor is real, but they’re not by any means all sociopaths. I would even doubt the 5% figure, although that perhaps begs definition. I’ve known only a few indisputable sociopaths in my life, and they have been — thankfully! — VERY few and far between.
@sukabi: Good luck with that. We can’t even get a guy admitting to a crime, encouraging others to commit crimes as he is recorded, and promising pardons to said criminals, indicted.
And most importantly to themselves, “earned” interest or other profits on those several million bucks.
Edited to put quotes around “earned.”
@The Moar You Know: Insurers don’t make money when they have to pay out on claims.
I’m really sorry for what happened to you, the illness and the treatment by UHC.
But it’s not just UHC. My insurer is BCBS. I had a serious illness that required a big dollar treatment. I made sure I got pre-authorization for the treatment and related care. Despite all this, BCBS denied every single claim related to my treatment. I spent hours most weeks toward the end of last year on the phone with them, disputing their denials. They have started to finally acknowledge that the first of the claims are covered, and hopefully they will cover the rest, but who knows.
After that, they wholesale denied claims from my PCP and specialists, all of who are listed on the BCBS website as in network (and on the hospital’s website as well), on the grounds that they were out of network. When I pointed out that they were listed on the website as in network when the care was provided, and are still listed as in network, I was told that their website may not be an accurate reflection of which doctors are in network and that they dropped out of network at some point, but at which date they could not tell me. If this is the actual case, they would still have to cover the care as a surprise bill, but I have a feeling that someone decided I had cost them enough money for the year and that everything that was submitted for me should just be denied, and they lazily put down the stupidest reason to deny coverage that they could think of.
@sukabi: I remember that doc from some Maryland university, that was the goto expert witness (for the coal/insurance companies) for all black lung cases: he *always* found that the lung disease wasn’t caused by coal, nosirree.
IIRC, he never faced any payback, any sanctions, any penalties.
@The Moar You Know: That sucks in more ways than one.
Chronic pain isn’t bad just for the pain.
@Alison Rose: I live in Canada now and the waiting is honestly comparable anyway; my partner waited almost a year to see a specialist in Michigan, and she had gold-plated University of Chicago insurance at the time AND the means to pay a decent chunk of fees. She waited slightly less to see the same brand of specialist here in Canada, and of course it was totally free.
Canadian progressives are constantly saying “oh don’t just say Canada is better than the US, we have so many problems too, it’s not better here, we need to make big changes” and like, yeah, there’s room for improvement, but having lived as a poor person on both sides of the border, they really are underestimating just how fucking evil the US healthcare system treats anyone who makes less than 6 figures, and just how desperate and scary it is to experience that. I once carved glass out of my hand with a razor blade because I knew we couldn’t afford a doctor’s visit, let alone surgery. “Might have to wait a day or two” is just orders of magnitude better than “hope it isn’t fatal and endure constant pain or go bankrupt”
@Alison Rose: That bit about Canadians waiting to see specialists always makes me roll my eyes. We wait for specialists here too.
Even specialists I am a regular patient of make me wait. That’s phrased wrong, they aren’t making me wait on purpose, their schedules are full up.
I heard about this on “1A” this morning. Absolutely horrifying.
@bbleh: your nym sounds like how you feel about them!
Yeah, they act like you can get a next-day appointment here whenever you want one. I’ve had to wait months in the past for appointments, once for my psychiatrist which was NOT IDEAL, a few times with an old dermatologist, and others.
If Republicans have their way in ’24 or soon after, everyone in this country will have United Healthcare-level insurance, or worse, or nothing at all.
I worked for a behav health ins co which shall remain nameless (fuckingbastards) and they would train/instruc us to reject claims regardless of their validity as people would overwhelmingly NOT fight the denial…esp people w/mental health issues. KaChing.
The Moar You Know
@mvr: it’s really bad for your ability to deal with people and be nice about it, I can tell you that. I snap at everyone these days.
@The Moar You Know: Yeah, anything that requires some calm or concentration or lack of fatigue.
@Alison Rose: Dermatologists are some of the worst. When I finally got an appt about 5 years ago, the doc I saw was frank (and sounded angry): She had known for a while in med school that she wanted to be a dermatologist.
She said it was really difficult to get a residency. And that the dermos already in practice basically conspire to limit new entrants to protect their ability to charge high prices.
Fast forward 4.5 years, and I cannot get an appt with this doctor, basically. Scheduling is a nightmare. I finally get an appt with a resident, and my old Dermo is the attending. I don’t blame her for not being able to see her directly, though she did treat me at this second appt. Pretty much none of the dermos in my entire network have appointments less than 5-6 months out.
What if the pre-cancerous little thingies she froze off had been more serious? 5-6 f***ing months of carcinoma growing is, uhhh, a bad thing.
See, but in the US, it’s an insurance company employee who denies your claim or forces you to wait for care, while in Canada it’s a government bureaucrat. I hope you can understand why one is wholesome and good and the other is the distillation of evil.
@Alison Rose: Yep, I pretty much have gold-plated everything when it comes to healthcare (due to my employer and because I don’t have dependents now, not because I’m raking in the big bucks). And I have GREAT docs (and nurses, and PAs, and…). But, I have plenty of waits, from the GP all the way through to spinal surgeons. Current issues cause lots of pain. All the time. As in, no sleep. Would be really nice to get things taken care of, like, now. I have yet to wait less then a month for each visit to each specialist, and usually delays are more like two to three months. My colleagues in Canada and France just shake their heads when we chat about this.
USA! USA! USA
ETA: I know how lucky I am compared to just about anyone else…in the US
<a href=”#comment-8753010″>@The Moar You Know</a>:
Yep, these days it takes a lot willpower for me to not snap at everyone all the time. It’s fatiguing, which just adds to the pain.
@The Moar You Know: Come sit by me. I’ve had chronic back pain since I was 27. I’ve learned to manage it, but I’ve wondered how much different I’d be without it. Some days it would be easier to say what parts of my body don’t hurt.
@The Moar You Know: My $$$,$$$ heart surgery in 2021 funded by UHC cost me $2,000 out of pocket. No trouble getting it approved.Maybe I had the gold coverage – will find out if Aetna* is worse now in 2023, since corporate daddy changed the plans this year
* Accolade sub-brand
Mental health coverage however was a super pain with UHC.
I have said it before here, for-profit healthcare is a crime.
Against the entirety of humanity.
You left out that last part.
The concept that a country can not take care of it’s citizens, can not provide equality in both humanity and in minimum financial support, for the cost of a wealth class that has far, far more than they ever need – at the cost in human life and humanity defies the concept of calling itself a democracy, especially one whose basic premise is equality, is one of the most damning of idiotic, asinine lies in human history
And yes, I’ve voted every time allowed, volunteered and served in it’s military during an asinine, unnecessary war, paid my taxes, and will continue to do that as long as I am physically and mentally able.
Yes, it’s nice to have a model where we are obligated to pay in, but they are not obligated to pay out.
@PJ: My late wife underwent chemotherapy. The cancer specialist group had multiple clinics and she was treated at one of their locations, but not their HQ. Every January bills started being denied as out of network. Turns out every January they reset their address file and forgot about all the branch clinics, thus claiming they were all out of network. We had to fight with them for weeks, every year, to get them to re-instate the branch clinics as valid in-network options.
I have had nothing but trouble with UHC in the few months I have had them. Granted I am older and have some complex needs but I’m not that bad. Just meds and a CPAP. It’s our employer provided insurance for a healthcare organization in Oregon. Every time I talk about it at work it’s like ringing a bell and everyone else chimes in with their tales of woe. Funny thing is most of us thought it was just our own situation but it’s all of us. Greedy, lying mendacious fcks is what they are. Their profits went up 100 percent year over year during the pandemic and I am pretty sure I know why. I’ve gotten to the point where I want to strangle that perky little shit that answers the phone with all that whistling and stuff. I’m going to start a bunch of us complaining to HR and maybe we can get Moda, like at my last job. They can be a little odd now and then but when I needed my retina fixed they paid the bills. Never said no to a thing. Our employers are great folks and I am pretty sure we can get the change done. I’ll be glad to pay more for effective care.
My heart goes out to all of you suffering needlessly through all this kind of crap. My god we need single payer healthcare!
It breaks my heart that someone who went to nursing school would be so lacking in empathy as to relish causing another human being pain.
For-profit healthcare is the worst.
Aetna has behaved similar to this- This article is kind of a useful howto for me for if it happens again. Im glad I lurk here to pick up this stuff — UC is no fun.
@NaijaGal: As someone who should earn his BSN in a few months, let me point out that hospital nurses have stressful, exhausting jobs, working 12-hour shifts at least 3-4 times a week and spending most of their time on their feet. Although the money’s good, there’s a lot of burnout, and many of the burnouts, who’ve already become deeply cynical, will choose to make less money but work Monday-Friday, 8-5-type jobs at insurance companies. The ones who stay in the hospitals are the ones who care about their patients. The ones who take jobs with insurers are the opposite.
@tokyokie: I work with some of the most empathetic nurses, including some who walked away from clinical positions to focus on classroom teaching because of burnout. That’s why the case stands out even more to me.
To your point, it goes beyond burnout to actively bury a report from a physician that shows the treatment you’ve decided to deny is necessary. And then to join in mocking the family for their reaction to the denial on a recorded call. All to help a company that made $20 billion in profits (and would lay you off in a heartbeat like John said) a little richer. Shudder.
Unless someone has directly experienced the crap side of the American medical system, they have a real difficulty grasping how bad it can be. Similar to voters hearing, but not believing, Republican policy proposals because they’re just so stupidly awful that they can’t be real.
And a few weeks ago David Anderson pointed at some state that was working on creating a Public Option and asked, “What problem was this looking to solve?” This. It’s looking to solve crap like this.
@Alison Rose: She probably went into nursing because it is a reputed to provide a good dependable income, then she discovered that she really doesn’t like sick people. So she applied for that corporate job where she could use her skill set to screw sick people.
Low Key Swagger
Every day I listen to my wife who is the nurse on the other side of the phone, advocating for her patients, who are children. It’s this weird kabuki like dance every time. The person above who said it is all designed to buy time is correct. The first step is to get the right person on the phone. She is always routed through numerous depts who all seem very sorry she was given their number, but they don’t address admissions, that’s somebody else. There are other tactics but in the end, it’s about winning more cases than they lose, and she has been informed that her dept is one of the few that show a profit year after year. She’s frustrated, but stoic as she has been doing this for 25 years.
My wife is a nurse/care manager. She has been saying the same thing for as long as she’s had to deal with them. She was taken aback (a little) when she recently saw that UH was highly rated (vis-a-vis consumers/patients). She could not understand how that rating came about.
@The Moar You Know: How awful! I’m so sorry you’ve suffered like this.
Snarki, child of Loki
Institute nationwide TRIPLE DAMAGES on insurance companies that do BAD FAITH to deny valid claims. Second offence: TEN TIMES DAMAGES.
Third offence? Summary execution of the CEO. Clearly incapable of learning, hence brain-dead.
They’re not going to get rectal cancer, they ARE rectal cancer.
J R in WV
Some Maryland University was actually Johns Hopkins, and yes, the radiologist was batting 1.000 on never finding black lung, ever. Despicable bastard. Miners with black lung are starved for oxygen, which is how both my parents died!
COPD, in Mom’s case caused by Phillip Morris Pall Malls and in Dad’s case caused by chemo to treat his leukemia caused by exposure to industrial solvents like benzene and Carbon Tet, back when they were standard solvents in print shops and garages.
It’s a horrible way to go, even with top medical care all the way!
J R in WV
Waiting for a specialist !!
Had a lumbar MRI early last December, diagnosed a spinal issue a misplaced disc causing a Spinal stennosis, a lack of spinal fluid movement. Have an appointment to see a neurosurgeon end of February. So nearly 3 months.
@different-church-lady: The mafia is jealous of the health insurance industry
Dunno if this is still effective, since I last needed to use it fourteen years ago after my elder son was struck by an SUV while crossing Atlantic Avenue in Brooklyn. At that time, insisting that BCBS provide me with a complete list of the employees who made the decision to decline coverage – including the educational attainments and licensure of each individual – caused them to back down PDQ. I suspect the reason was the huge percentage of MBAs on the review board – and the dearth of fully qualified medical practitioners. Perhaps they realized that letting a bunch of kids with questionable degrees in business refuse insurance coverage for a profoundly disabled person wouldn’t look good if and when the case went to court. YMMV, of course.
Penn State looks awful too