How far will your health insurance go to protect itself ahead of you? It might depend merely on how much your treatment costs.
A recent piece in ProPublica covered the story of an insurance bad faith lawsuit in Pennsylvania against United Healthcare, one of the nation’s largest insurers. The company offers a nearly every kind of health insurance plan, including Medicare supplemental insurance that has been coming under fire recently for overbilling.
Investigative journalists for ProPublica shared the story of a college student’s struggle with his health insurance to pay for necessary, and expensive, treatments for debilitating ulcerative colitis. The young man’s condition was incapacitating, and treatment after treatment found him no relief, until an almost magical combination of drugs at unusually high doses proved remarkably helpful. Thanks to the medications he was able to live a mostly normal life again.
The treatment was, indeed, expensive. His insurance was being billed for more than $1M per year. The student, though, had paid all of his health insurance premiums, and was pursuing the treatment his expert gastroenterologist was prescribing him – because nothing else had worked for years. This annual expense, though, was more than United Healthcare, which made a profit of $20.1 Billion in 2022, was willing to pay. So it contrived reasons to deny coverage, the lawsuit alleges, and reported to the student that he needed to find alternative, less expensive, treatment or find an alternative way to pay. The thing was, these decisions were not being made, nor agreed to, by his actual doctors. United HealthCare was finding doctors to agree with its position, suppressed opinions that disagreed with it, and misrepresented what this doctors were saying.
After threats of denials – that were going to imminently cause harm to his health – he filed suit against United Healthcare alleging bad faith. The case is ongoing in Pennsylvania, so resolution of some sort is not on the immediate horizon.
Top executives for United Healthcare make a tremendous amount of money. The recently retired CEO collected $140M in 2020, between salary and exercised stock options. And on the consumer side, they were fighting tooth and nail to provide care to their insured that totaled 1/100th of that.
We have previously written about insurance denials affecting needed medical care. This is simply one of those egregious examples of insurers protecting their bottom line at the cost of their insured’s health and wellbeing.
