> Earlier this year, a Senate committee investigated Medicare Advantage plans denying nursing care to patients who were recovering from falls and strokes. It concluded that three major companies — UnitedHealthcare, Humana and CVS, which owns Aetna — were intentionally denying claims for this expensive care to increase profits. UnitedHealthcare, the report noted, denied requests for such nursing stays three times more often than it did for other services. (Humana had an even higher figure, denying at a rate 16 times higher.)
> As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan.
> At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment.
https://www.cnn.com/2018/05/13/health/liver-transplant-mom-e... has a nice illustrative example of how silly the system UnitedHealthcare and others set up can get.
https://www.nytimes.com/2024/12/05/nyregion/delay-deny-defen...
> Earlier this year, a Senate committee investigated Medicare Advantage plans denying nursing care to patients who were recovering from falls and strokes. It concluded that three major companies — UnitedHealthcare, Humana and CVS, which owns Aetna — were intentionally denying claims for this expensive care to increase profits. UnitedHealthcare, the report noted, denied requests for such nursing stays three times more often than it did for other services. (Humana had an even higher figure, denying at a rate 16 times higher.)
https://www.propublica.org/article/unitedhealth-healthcare-i...
> As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan.
> At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment.