[Unknown Member]

Before being pushed out of its network, United denied approximately 18% of commercial claims submitted by Envision. That number spiked in November 2021 to approximately 48% of all submitted claims. For the highest-acuity care claims, United callously and automatically denied approximately 60% of commercial claims.

[farzadahmadimedrn710_43]

So that 90 million is all going to the bond holders before the docs see a penny?

[drathavan95_51]

So the RP CEO quickly pushed this article out on LinkedIn. My guess, as a message designed to strengthen RP’s argument in the UHC v RP matter in the eyes of the readers… Something to consider, Envision wasn’t using a contract which had very specific provisions and limitations to bill UHC 6X Medicare rates, even when the services were not performed by that group, in that group’s hospital or by that group’s physician owners. Envison argued and successfully proved that they were intentionally underpaid and or denied on the services that they performed. Conversely UHC is arguing that RP over billed and was over-paid for the services it performed and that RP’s actions were a breach of the original contract. I don’t see RP winning their case – Envision had sound arguments, RP does not. It is no secret I am no fan of either Envision or RP for a combination of personal and professional reasons but what really truly bothers me here is that the real losers are the physicians and the patients. UHC continues to get fat and RP’s owners have already skimmed plenty from the backs of the radiologists. The healthcare system is broken. Consolidation under the Envision and RP model doesn’t work. Independent medicine doesn’t work when expenses go up and when reimbursements go down. It’s time for a new approach, one that takes the best of both worlds, private practice and corporate practice and brings it all together. The first thing that needs to change is non-physicians telling physicians how to practice medicine. The practice of medicine belongs ONLY in the hands of the physicians, never the administrators. 

[Patrick]

In a nation obsessed with equity. Why did Singleton deserve a higher level of reimbursement than Methodist or any other Houston practice? Quality? I doubt it! Complexity? Even less likely. It was more likely about the specific suburb and companies paying for insurance.

[Radscatter]

This variation in insurance contracts is crazy. I get a medicare multiple of 1.1x with United. I know that the group across town gets 1.5x. You go to another state and get 6x! 
 
Kinda sh!tty that I got to do 6 times the work to get pain the same! 

[ruszja]

Quote from NYC

In a nation obsessed with equity. Why did Singleton deserve a higher level of reimbursement than Methodist or any other Houston practice? Quality? I doubt it! Complexity? Even less likely. It was more likely about the specific suburb and companies paying for insurance.

What you get from united is a function of your market position and skill at negotiating.

At some point around 2015 I realized that UHC was 3% of our revenue and 90% of the appeals work. They routinely pre-approved surgeries and then refused to pay at the back end. So at the next 30 day window to cancel we dropped the contract. For the next 4-5 years I kept getting regular calls from their contracting rep making offers in increasing multiples of Medicare to return to the fold. My answer has always been: ‘At UHC you are lying scoundrels. I hope you all die of a disease that manifests with painful boils. There is literally no amount of money that would get us to re-join UHCs network.’

[mwakamiya]

Things like this will be fodder for the supporters of nationalized medicine. 

[buckeyeguy]

It is a sad state of affairs. The culture of integrity has been gone a long time, and that is a byproduct of multiculturalism and the debasement of money/the monetary system by our “leaders.”

[smfst7_929]

Yeah I dont think anyone has any love for United or health insurance companies in general. Just funny to watch two greedy companies duke it out. Kind of hope for both of them to lose to be honest. But first lets take out radiology private equity. They are a scourge that should be uprooted before it takes hold. Sadly insurance companies are not as easy to uproot