Bob Herman

I think every health insurance company out there is known for their denials to some degree. Specific rates of denials are tough to come by, but insurers, especially the for-profit ones that sell on the stock market, they have an incentive to deny care.

I think every health insurance company out there is known for their denials to some degree. Specific rates of denials are tough to come by, but insurers, especially the for-profit ones that sell on the stock market, they have an incentive to deny care.

You know, there have been so many issues with denials over the years, and my colleague Casey Ross and I reported on a big one within Medicare Advantage, and that's the program for older adults.

You know, there have been so many issues with denials over the years, and my colleague Casey Ross and I reported on a big one within Medicare Advantage, and that's the program for older adults.

You know, there have been so many issues with denials over the years, and my colleague Casey Ross and I reported on a big one within Medicare Advantage, and that's the program for older adults.

And UnitedHealthcare is the biggest in Medicare Advantage, and they, over the past several years, they've been using algorithmic prediction, predictive tools, and artificial intelligence to basically ramp up denials specifically in post-acute care, and that's the care that somebody gets when they leave the hospital.

And UnitedHealthcare is the biggest in Medicare Advantage, and they, over the past several years, they've been using algorithmic prediction, predictive tools, and artificial intelligence to basically ramp up denials specifically in post-acute care, and that's the care that somebody gets when they leave the hospital.

And UnitedHealthcare is the biggest in Medicare Advantage, and they, over the past several years, they've been using algorithmic prediction, predictive tools, and artificial intelligence to basically ramp up denials specifically in post-acute care, and that's the care that somebody gets when they leave the hospital.

So especially on that side of the coin, post-acute care denials have been a very big issue for United.

So especially on that side of the coin, post-acute care denials have been a very big issue for United.

So especially on that side of the coin, post-acute care denials have been a very big issue for United.

Yeah, so let's say someone goes to the hospital and then the hospital says, okay, you're ready for physical therapy, occupational therapy, speech therapy. Let's send you to a rehab facility, a nursing home. So a person will go there and they'll start their physical therapy. And behind the scenes, United Healthcare has used a tool called NaviHealth.

Yeah, so let's say someone goes to the hospital and then the hospital says, okay, you're ready for physical therapy, occupational therapy, speech therapy. Let's send you to a rehab facility, a nursing home. So a person will go there and they'll start their physical therapy. And behind the scenes, United Healthcare has used a tool called NaviHealth.

Yeah, so let's say someone goes to the hospital and then the hospital says, okay, you're ready for physical therapy, occupational therapy, speech therapy. Let's send you to a rehab facility, a nursing home. So a person will go there and they'll start their physical therapy. And behind the scenes, United Healthcare has used a tool called NaviHealth.

And there's an algorithm within the company that basically looks at the patient's demographics, how sick they are, their history. And tries to come up with some kind of prediction of how much time they'll need in that nursing home. Let's say it's 16 days. That's what the algorithm says. After 16 days, you should be good. Now, if it's used as a guide, that's fine.

And there's an algorithm within the company that basically looks at the patient's demographics, how sick they are, their history. And tries to come up with some kind of prediction of how much time they'll need in that nursing home. Let's say it's 16 days. That's what the algorithm says. After 16 days, you should be good. Now, if it's used as a guide, that's fine.

And there's an algorithm within the company that basically looks at the patient's demographics, how sick they are, their history. And tries to come up with some kind of prediction of how much time they'll need in that nursing home. Let's say it's 16 days. That's what the algorithm says. After 16 days, you should be good. Now, if it's used as a guide, that's fine.

But in many cases, I mean, we found documents that said... that United told their case managers, you have to stick to the algorithm.

But in many cases, I mean, we found documents that said... that United told their case managers, you have to stick to the algorithm.

But in many cases, I mean, we found documents that said... that United told their case managers, you have to stick to the algorithm.