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I worked at UnitedHealthcare for about nine months in the medical claims department. After extensive training, I was taught various ways to deny claims, which was frustrating given the complexity of the policies. One case involved a widowed woman whose husband had just died from pancreatic cancer. She was facing court over a hospice claim, and they were garnishing her wages within 60 days of his passing. Despite her desperate situation, the company insisted on denying her claim. Eventually, I was able to approve a significant payment, but they expected her to cover it without any insurance. I couldn’t continue working there, so I quit and took a job fighting insurance claims from the other side. My experience taught me a lot about navigating the insurance system, especially with UMR, a branch of UnitedHealthcare.

I am literally telling you that they're murdering these people, and nobody will listen to me. These people aren't dying from COVID. They don't care what is happening to these people. They don't. I'm literally coming here every day and watching them kill them. It's like going in the fucking twilight zone. Like, everyone here is okay with this. The only way I can kind of put this into context for everybody is an extreme example: He's like, if we were in Nazi Germany and they were taking the Jews to go put them in a gas chamber, I'm the one like, they're saying, hey. This is not good. This is bad. We should not be doing this. And then everyone tells me, hang in there. You're doing a great job. You can't save everybody. But these people aren't dying from COVID. Let me give you several examples here. An anesthesiologist intubated the patient’s right bronchus and of a patient, and they couldn't get the stats up. For about five hours, we were waiting on a chest x-ray to confirm that the placement was wrong. In the meantime, while we're waiting for that, and we've told the anesthesiologist that it was placed wrong because, like, literally only one side of his fucking chest is inflating, he dies. A patient had a heart rate of 40, and the resident starts doing chest compressions on him, which is not what you do. You just externally pace them or you give him some atropine. Then I run in there to stop him from doing chest compressions on somebody with the fucking pulse. And then he decides to push epi. He throws some pads on him to defibrillate the guy in bradycardia. Okay? He has a heart rate of 40 and a stable, you know, bradycardic rhythm. We just need to give him, like, somatropine and pace him. He fucking defibrillates him and kills him. I ran out of the patient’s room to get the director of nursing who was standing out there. And I’m like, can you stop him? He’s going to kill that patient. He’s going to kill that patient if he defibrillates him with bradycardia and a heart rate of 40. The director of nursing just shook his head, and I turned around, and he killed the dude. There was a nurse who placed an NG tube into some guy’s lungs and filled his lungs with tube feeding. There was a nurse who confused a long-acting insulin with a short-acting insulin and gave thirty units of a fast-acting insulin and killed the guy. It’s just here they’re just gonna let them rot on the vent. They’re medically mismanaging these patients. And, like, I’m not a doctor, but there’s basic standards of care. When somebody’s low on blood, literally on the brink of a critical low blood level, we should replace the blood. I asked the residents, and they’re like, does he have internal bleeding? And I said, no. Then they’re like, well, we’re not replacing the blood. In these COVID patients, they all eventually need a blood transfusion. Their blood—if you don’t have enough blood to oxygenate your body, the vent settings don’t fucking matter because you have no oxygen carrying capacity of your blood. We have a nurse who fell asleep at the nurses’ station while we were all in rooms, and her norepinephrine ran out. And the guy had no fucking blood pressure and didn’t perfuse his brain, and I’m pretty sure his brain dead. That same nurse is now running a CRRT machine, a dialysis-like machine, that she has never done before. She said she’ll figure it out. I’m pretty fucking smart, and I figure a lot of shit out, but I would never attempt to try and figure out a CRRT machine on the fly. We are adequately staffed. There’s a shit ton of staff in there, like, and we have a nurse who does CRRT in there. She has a different patient load. We told them, swap these nurses so the one that knows how to work this machine can work this machine, but they didn’t wanna do that. So I’m pretty sure that patient will be dead here in a couple hours. Nobody is listening. They don’t care what is happening to these people. They don’t. I’m literally coming here every day and watching them kill them. I mean, we’re not gonna save everybody. That’s fine. Like, come on, guys. We’re not God. Some of these people are just on sedation to keep them on the vents. Nothing else. I have a lady on a tracheostomy on a vent, and she’s not even fucking cognizant. She’s not even on sedation. You know what we give her every day? I give her breathing treatments, albuterol, and she gets insulin. And that’s it. We’re not treating the COVID, guys. For real, we’re not treating the COVID. You know, every day, we try and get these guys off the vents. Right? Because there’s criteria for weaning. Every day, the day shift nurse will wean them down to minimum sedation. Every night, we come in and we get the same two residents and they fucking max out all the sedation again and undo all the work from the day shift. Then the day shift attending will come in, and they’ll all do rounds. And they’ll be like, he wasn’t synchronizing with the vent. So we had to turn all the sedation on. And I’m like, he wasn’t synchronizing with the vent because it’s in the wrong vent mode. I even tried getting a hold of Black advocacy groups here. They just put me on hold or hang up on me. Tried talking to management. Now I got new units. And someone come up with some type of a solution for me because I’m kind of out of ideas. You know, I try and talk with some of the other nurses here, and they’re like, well, you can’t save everybody. And they all know what’s happening. They all agree with me and they all just shake their heads and I’m like, am I the only one who is not a sociopath to think that this is okay? I mean, guys, they literally don’t even know when they’re dead. Like, how many times have I told you they’ve assigned me a dead person? Like, how long have they been dead? Nobody knows. Like, how is anybody assessing anything without a stethoscope? Normally, we have disposable stethoscopes, but I brought my old chunky one. Nobody has listened to anybody’s lungs as long as I’ve been here. Even with disposable stethoscopes. I keep telling them that, you know, the guys are like, my patient’s going acidosis. We need to do something about this before his kidneys shut down. Then they run five liters of bicarb into a person who’s gained 20 pounds of water weight and completely throw him into heart failure, and he dies several hours later. That was one of my patients. So I let them know. They had me start the bicarb before I left one night. And by the time I came back the next shift, he was dead. And they assigned him to me, and he was already in a body bag. Like, guys, they’re not dying of COVID. I am literally telling you that they’re murdering these people, and nobody will listen to me. My lead at the other hospital warned me I’d have a problem and advocate for the patients too. They moved him to a completely different hospital. I tried reaching out, but he hasn’t texted me. I’m going to the unit. Let’s see how they kill him there. Okay? Stay safe. Stay out of NYC for your health care.

New developments in the UnitedHealth CEO saga reveal troubling aspects of their physician contracts. A specific clause states that whether a treatment is covered should not determine if it's provided, implying that healthcare professionals should offer necessary care regardless of insurance coverage. This shifts responsibility from the insurance company to the provider, potentially leaving them liable for care that may not be reimbursed. It's shocking that such a clause exists, and there seems to be a lack of regulatory scrutiny, such as class action lawsuits or investigations by agencies like the FTC or SEC. This situation raises significant concerns about accountability in healthcare. What are your thoughts? Leave a comment below.

Health insurance companies, particularly Blue Cross, are becoming more challenging in authorizing treatments. When physicians request authorization, they often face a peer-to-peer review process, where they must speak to an insurance-employed doctor who typically denies requests. Previously, these calls were scheduled to accommodate the physician's availability. Now, Blue Cross has changed its approach: they will only call once, without notice or identification of the number. If a physician is busy with patients or has their phone on do not disturb, they may miss this call, resulting in denied treatment authorization.

A family practice physician in San Diego recounts a bizarre experience where her patient's insurance denied a wheelchair request for a double amputee, citing a lack of documentation on how his walking was affected. This highlights the problematic prior authorization process, which often delays necessary treatments. One case involved Kathleen Valentini, whose MRI for hip pain was denied, leading to a delayed cancer diagnosis and ultimately an amputation. Reports show that 80% of doctors say patients abandon treatments due to prior authorizations, which can result in life-threatening situations. Insurance companies claim these processes prevent unnecessary procedures, but many argue they are more about profit than patient care. Legislative efforts are underway to reform prior authorization, but the system remains flawed, with some suggesting a return to a "pay and chase" model that allows doctors to make decisions without insurer interference.

A 35-year-old patient with aggressive breast cancer and a family history of cancers underwent a mastectomy last year. Her insurance initially denied a prophylactic mastectomy on the other breast. After radiation and chemotherapy, the patient wanted the other breast removed due to worry, which the speaker deemed reasonable. The insurance company denied a second request, but after appeals, a doctor at the insurance company overturned the decision, approving the prophylactic mastectomy. However, the insurance company then contested the timing of the DIEP flap reconstruction, wanting the surgeon to wait six months after radiation, against the surgeon's judgment that four months is sufficient. The speaker asserts that the insurance company is practicing medicine by dictating the timing of the surgery.

In 2025, insurance is worsening. A surgeon was called during a bilateral deep and expander procedure by UnitedHealthcare, demanding information about a patient currently undergoing surgery. The representative needed the patient's diagnosis and justification for an inpatient stay. The surgeon explained the patient had breast cancer and was currently asleep, but the representative claimed that information was handled by a different department, despite the surgeon having received prior approval for the surgery. The surgeon emphasized the need for the patient to stay overnight and expressed frustration with the insurance situation, stating it is out of control.

Patients are being harmed due to gross negligence and medical mismanagement. Despite witnessing numerous incidents, no one seems to care. Examples include incorrect intubations leading to death, inappropriate defibrillation on stable bradycardic patients, and nurses failing to monitor vital equipment. Basic standards of care are ignored, such as not administering blood transfusions when needed. Patients are sedated without proper treatment for their conditions, and critical assessments are overlooked. The environment feels like a twilight zone, where the urgency to save lives is dismissed. Attempts to advocate for better care have been met with indifference, and the situation appears dire, especially for marginalized communities. There’s a desperate need for intervention to prevent further harm.

A doctor explains why some physicians are no longer accepting insurance, citing the practice of "clawbacks." The doctor performed an operation in February and billed the patient's insurance. The insurance company paid about a third of the billed amount. Four months later, the insurance company sent a letter stating they overpaid and demanded a refund. This "clawback" means the insurance company believes it overpaid for a service rendered months prior and demands repayment, threatening to withhold future payments if the doctor doesn't comply. The doctor states that such practices create stress and make small practices unsustainable, making it difficult to budget and project future finances. The doctor poses the question of whether one would continue working for an employer who demands repayment months later. The doctor claims that these underpayments and clawbacks contribute to insurance companies' large profits and that doctors drop insurance to avoid these issues and sustain their practices while providing good patient care.

It's 2025, and insurance issues are worsening. During a surgery, I received a call from UnitedHealthcare demanding information about a patient who was under anesthesia. They wanted to know her diagnosis and if her inpatient stay was justified. I explained that she was asleep and had breast cancer, but the representative claimed he wasn't informed and directed me to another department. I emphasized that she needed to stay overnight and that I had already received approval for the surgery. This situation highlights how out of control insurance has become.

You want to speak with her? I can get her on the call. We're dealing with numerous denials weekly. My name is Julie, and we face significant challenges with insurance companies. Despite our efforts, we receive cease and desist letters for speaking out on social media. Patients share their struggles with chronic pain and the impact of insurance decisions on their treatment. We work tirelessly to secure necessary medications, often spending countless hours on appeals. Even experienced healthcare administrators find the process exhausting. Recently, an insurance company reversed a denial after our appeal, highlighting the importance of persistence. Patients question how insurers determine their treatment needs, especially when it affects their quality of life. The current health insurance system in the U.S. is deeply flawed and needs reform.

I’m witnessing severe medical negligence every day. Patients aren't dying from COVID; they're being killed by poor care. For example, an anesthesiologist improperly intubated a patient, leading to his death, while another patient was defibrillated despite having a stable heart rate. Nurses are making critical mistakes, like placing feeding tubes in lungs and administering incorrect insulin doses. Even when patients are critically low on blood, they aren’t receiving transfusions. Staff are overwhelmed, and management ignores the issues. I've tried advocating for patients, but no one listens. The situation feels hopeless, and I fear for the lives of those in my care. I need help to address this gross negligence before more lives are lost.

I work in a hospital in Broward County, Florida. The nurse manager informed us that our anesthesia recovery unit will be used for COVID patients and that surgical patients' families cannot visit. I questioned how they knew there would be a crisis next week, and the manager responded that we should already know what's happening. Others seemed unfazed by this, but I find it strange and believe it's time to bring down this corrupt system. I'm really unhappy with my job because of this corruption.

I received a letter from United denying my patient's overnight stay, and I want to share it fully. My previous statements were honest, and I’m open to questions about the letter. I refuse to be silenced by threats when advocating for my patients and addressing issues in the healthcare system. Speaking out is essential for maintaining my integrity and making a difference. As a woman caring for women with breast cancer, I am committed to this cause. I encourage everyone to share this story and stand up against the powerful healthcare organizations. It’s vital for us all to tell our stories to drive change, and I am dedicated to this mission.

I was reprimanded for not intubating a COVID patient immediately despite their improving condition. In the US healthcare system, there is pressure to intubate quickly, even if other reversible causes could be addressed first. In graduate medical education, there is no recourse or defense against such reprimands. Unfortunately, the patient did not wake up and could not be taken off the ventilator. This highlights the challenges of trying to do what is best for the patient in this system.

I received a letter from my health insurance stating they won't cover one of my chemotherapy sessions costing $15,000. My doctor had previously confirmed approval for my treatment, so I'm confused and worried this could mean they won't cover future sessions. I rely on chemotherapy every three weeks for my stage 4 cancer, and I can't afford that cost. If they stop covering it, my doctor might have to switch me to a cheaper treatment that may not work as effectively. My recent MRI showed my tumors have shrunk slightly, but the risk of nerve damage and paralysis was real. This letter feels like a threat to my life, as it jeopardizes my access to life-saving treatment.

You want to talk to her? I can get her on the call. We're dealing with a lot of denials—about 50 a week. My name is Julie, the practice manager. We’ve faced backlash from insurance companies like Aetna and Cigna for speaking out on social media. Patients describe their struggles with chronic pain and the impact on their lives. After starting treatment, one patient felt relief, only to face insurance denials for necessary infusions. We work hard to appeal these decisions, spending countless hours on cases. Even experienced administrators find the process exhausting. However, we’ve had success in getting approvals after appeals. Patients deserve better; insurance companies shouldn’t dictate their quality of life. The health insurance system in the U.S. is fundamentally flawed and needs change.

The current state of American healthcare involves a lengthy process for getting insurance approval for necessary procedures. A cardiologist submitted a request for a patient’s procedure, but it was denied, requiring additional information. After resubmitting data, the insurance company still denied the request, necessitating a peer-to-peer review. This involved scheduling a phone call with an insurance-employed doctor, which took nearly two weeks of back-and-forth communication and long hold times. Ultimately, despite all efforts, the procedure is likely to be denied again.

UnitedHealthcare has allegedly disappointed a speaker because they denied a patient's MRI with advanced sequences needed for tumor surgery and also denied a peer-to-peer review. The speaker thought things would improve after public complaints, but claims UnitedHealthcare is removing avenues for appealing denials by replacing peer-to-peer reviews with a form that will be faxed back at an unspecified time. The speaker states the patient needs the MRI for safer brain tumor surgery. The speaker implores UnitedHealthcare to simplify the appeal process if they continue to deny crucial scans or labs necessary for safe patient care.

Eighty-five percent of Americans report negative experiences with pre-authorization. In 2023, the Medicare Advantage Program, covering 32 million people, denied 3.2 million initial prior authorization requests. Physicians handle about 40 pre-authorization requests weekly, spending around twelve hours on related paperwork. This frustrates doctors, delays care, and erodes trust in the healthcare system. Health and Human Services and CMS are pursuing private solutions to address prior authorization issues. A recent roundtable with CEOs representing 75% of all covered lives in America, approximately 260 million people across Medicare Advantage, Medicaid, and commercial insurance, addressed this problem. There is significant industry interest in resolving these issues.

I do my best to help parents understand medical interventions they signed off on, but it's concerning when they can't provide necessary information.

Medical bills can be confusing, as seen in the case of an emergency appendectomy that cost $90,000, which insurance initially refused to cover, questioning its necessity. This situation highlights the issues with health insurance regulations in the U.S., where insurance companies have significant control over what is deemed necessary medical care. To manage costs, insurers implement measures like utilization management and prior authorization, which can lead to denials of coverage. These practices are longstanding and often criticized by physicians, who advocate for policy changes. While Medicare is making some adjustments, progress is slow.

I just had a frustrating call with an insurance company regarding a patient's care. The insurance doctor questioned why I ordered certain treatments for a baby, despite established guidelines. I had the guidelines in front of me, but she didn't even have her password to access them. After explaining the medical necessity, she reluctantly agreed to approve the request but suggested that maybe the baby didn’t need such intensive care. I firmly stated that we take infant health very seriously. It’s disheartening to see some doctors prioritize insurance profits over patient care. There should be a clear line drawn when it comes to the value of human life in medicine.

UnitedHealthcare hired Clairlocks, a firm known to threaten journalists. Doctor Elizabeth Potter publicly called out health insurance, going viral after she stepped out of surgery to deal with a United rep. Potter alleges UnitedHealthcare is retaliating against her, potentially bankrupting Redbud Surgery Center, which she opened in 2024 to reconstruct living breast tissue using patients’ own skin and fat. The center is not in network with them. Potter says United's communication stopped after her viral video. She says being out of network would be 'a huge deal' and financially devastating, and that 'they demanded she take down her viral video and apologize.' United claims the decision came before the video. The story notes other actions against media: The New York Times, The Guardian, and Bill Ackman; Potter raised over $500,000 to keep Redbud open.

Dr. Potter is speaking with an unnamed doctor from United Healthcare to discuss a patient's breast reconstruction. Dr. Potter wants to understand why United is denying coverage for a procedure to preserve sensation, involving dissecting the fourth intercostal nerve and grafting it to dermatosensory elements on the nipple. Dr. Potter requests the evaluation and reasoning behind United's decision, wanting to review the data and references used, but is told it's an internal resource and cannot be emailed. Dr. Potter cites data from 2023 and 2024 supporting the procedure's effectiveness and emphasizes that this is the patient's only chance for sensation preservation. Dr. Potter expresses concern that United is practicing medicine by making medical determinations and states they will file an internal appeal. Dr. Potter voices frustration at not being able to speak with the United doctor as a peer.