UnitedHealthcare

I know that hurt.

you know, instead of a hundred dollars, can I send her $200 this month? You know, you never in a million years call United Healthcare and be like, can I pay you more this month for my health insurance? Like that's just never going to happen.

And so there's this altruism that I think is in us, is in our souls that we want to help other people given the opportunity.

And that's what we do is we help other people in the community.

And in fact, we unfortunately we had a guy who stopped outside of our house five or six times in a blacked out car.

And then ultimately I got a message that says, I'm going to effing kill you all.

And so we had to have, you know, austin police department you know surround our house for a period of time because we thought this guy was going to come and you know and take us out you can imagine like i can take that but my wife and kids were there and my kids are like who at the time were probably six and eight or freaked out right and so um you know we have to just go through that um and and so that's one way in which we're seeing this i had to increase security and all that kind of stuff which is terrible especially after you know the united healthcare guy um You know, a couple a couple of years ago.

Right.

Let's do it.

So Elevance was the second payer after UnitedHealthcare to report earnings last week.

It was, I think, like a pretty standard story.

Elevance is running the same playbook as the majority of the payer market right now.

Before we get there though, Molina rate versus trend math.

I had some fun with Molina's earnings call.

They are the only payer so far out of Elevance and UnitedHealthcare to share by segment information on spend, revenue, and membership.

With all three of those, you can get a picture for what is happening with the rates and trends.

Now the audit included a sample of 230 where program enrollees had reported a high risk diagnosis in service years 2019 and 2020.

UnitedHealthcare would have then received risk-adjusted payments for payment years 2020 and 2021.

200 of these samples were related to the high-risk diagnosis groups, and 30 of the samples were those potentially mis-keyed, mis-entered diagnoses.

Now, the good news here is that for 58 of the sample of 230, medical record documentation supported and validated the reported HCC.

Now, while that's a large number, this was just the sample.

So based on those results, the OIG estimated that the total overpayment based on unvalidated HCCs for 2020 and 2021 was $24,465,369.

Now, UnitedHealthcare does disagree with some of the findings, and I encourage you and your staff to review the full audit report.

I have included the link to the report in my article this week.

I mean, you see the support that Luigi Mangione got.

After striking down the UnitedHealthcare CEO.

That stuff is everywhere.

You can't deny it.

Did he call out the whole state? If he's paranoid about getting shot because he's on a pedestal and when you're at your top and you're making $100 million a year and you're a public figure, you're kind of at risk, right? No matter if you're a politician or anything.

I mean, we saw the guy from the UnitedHealthcare get sniped.

Yeah.

So it's like I get that where I think that thought would always be in my mind.

I don't mind those topics either, but it's always good to talk about things that will help our friends and family.

And I want to bring up A recent policy in UnitedHealthcare's approach to mental health.

This is the same company that denied so many claims.

Their CEO got shot in the back, which I don't condone, but I understand why it might have happened.

Yes.

We now have that UnitedHealthcare person for every region in the country.

But it has taken us so much effort to find.

We're looking for a network manager, a provider contracting manager, a network development manager.

He's launched and scaled conversational AI products at companies like Pando Networks, backed by Intel Capital, and led product strategy at Howdy, where he helped build the Stack API ecosystem before Microsoft acquired the team.

He's since done enterprise conversational AI work for Walmart, Lowe's, Rabobank, and United Healthcare, and at Microsoft Co-Pilot Studio, helped spearhead enterprise-grade generative AI capabilities.

His firm, Toilville, is AI-aware but technology agnostic because Peter believes the best asset any organization has is the human minds that shape it.

Today, Peter shares why so much technology is being deployed in ways that are short-sighted and frankly unempathetic, cutting costs without actually solving the real problem.

So I have to accentuate the positive here.

And that's what you hear after the murder of UnitedHealthcare CEO Brian Thompson, where you had prominent Democratic politicians from.

Alexandria Ocasio-Cortez to Elizabeth Warren to Chris Murphy to Bernie Sanders, all of them condemning the murder, but then saying, but throwing throwing a really pregnant.

But after that, you have to understand that everybody's so angry.