“Tear It All Down"

As I write these words Dr. Zachary Levy's patient is fighting for their life, hooked to machines and deep in a coma. However, UnitedHealthCare deems this patient’s battle ‘not medically necessary’ as Group’s CEO Andrew Witty tells executives they will “smash financial records” this year. Has Unitedhealthcare and others like it really become this heartless.

United Healthcare @UHC just denied a claim on one of my patients in the ICU with:

-- a brain hemorrhage
-- in a coma
-- on a ventilator
-- in heart failure

...because I haven't proven to them that caring for her in the hospital was "medically necessary".

Tear it all down.

— Zachary D Levy MD 🇲🇦 🇨🇮 (@ZLevyMD) December 31, 2024

This isn't an isolated incident. One in three claims denied in 2023 - twice the industry average. A Senate investigation reveals algorithms overriding doctor decisions. Former employees expose systematic training to deny claims.

UnitedHealthcare claims they approve 90% of claims upon submission. The reality? according to data from the Centers for Medicare & Medicaid Services, they dismissed one in every three claims in 2023 - double the industry average of 16%. 

A Senate investigation revealed the company's Navi Health subsidiary used algorithms to deny care for seniors in Medicare Advantage plans. The system had a 90% error rate, yet they continued using it, banking on the fact that only zero point two percent of patients would appeal.

The strategy is working. Last year alone, hospitals spent $20 billion fighting denials. Meanwhile, UnitedHealthcare reported operating profits exceeding $16 billion.

In April 2021, UnitedHealthcare's committee approved 'Machine Assisted Prior Authorization' to streamline claims processing.

What followed was unprecedented. Their denial rate for post-acute care doubled from 10.9% in twenty twenty to 22.7% in twenty twenty two.

For skilled nursing centers, denied claims in twenty twenty two were nine times higher compared to twenty nineteen.

The system responsible was nH Predict, developed by UnitedHealth's subsidiary NaviHealth. While the company claimed it was merely a 'guide to help inform providers,' internal documents revealed employees were pressured to keep patient rehabilitation stays within 1% of the algorithm's predictions.

The pattern was systematic. Elderly patients were being prematurely removed from facilities or forced to drain their savings to continue care. When federal administrative law judges heard appeals on these coverage denials, about 90% were reversed - but only a tiny fraction of patients ever filed appeals.

According to ValuePenguin's analysis of federal data, UnitedHealthcare had the highest denial rate among insurers on the Affordable Care Act exchanges, rejecting nearly one-third of all claims.

Dr. Zachary Levy's ICU patient lies in intensive care with a brain hemorrhage, in a coma, on a ventilator, and in heart failure. The doctor had to write a letter explaining why preventing death was 'medically necessary'.

A college student faced $2 million in annual medical claims for ulcerative colitis treatment. UnitedHealthcare not only buried their own internal report deeming the treatment essential but also misrepresented critical findings and ignored warnings from doctors about the risks of altering his drug plan.

While battling stage 3 cervical cancer in 2016, one patient was denied coverage because UnitedHealthcare claimed her diagnosis 'was due to an accident.' When she called to ask how she could have accidentally caught cancer, the agent explained that a third-party company automatically denies everything on first review.

The Commonwealth Fund survey reveals nearly one in six reported that care denials delayed the diagnosis of a serious health problem. The Kaiser Family Foundation, an American non-profit, found that individuals facing claim denials are significantly more likely to experience delays in necessary care, deteriorating health conditions, and increased out-of-pocket expenses.

Most disturbing is how few fight back. Of the millions of Americans who face claim denials, only zero point one percent file formal appeals. When they do appeal, about half receive some form of approval - but by then, the damage is often done. Nearly sixty percent report delayed care, and among those, almost half say their health issues worsened during the waiting period.

Former employees reveal systematic training to deny claims and rush distressed customers off phone lines. Meanwhile, as patients struggle with denials, UnitedHealth Group reports operating profits exceeding sixteen billion dollars last year on two hundred and eighty one billion dollars in revenue.

The human impact is devastating. Yolonda Wilson's surgery was denied just two days before the scheduled date. A father posted about his son with cerebral palsy being denied a wheelchair. One patient's scan for stage four lung cancer was recently turned down.

As this pattern continues, troubling questions emerge. How did algorithms become judge and jury over medical decisions? A Senate investigation revealed NaviHealth's AI system had a ninety percent error rate, yet continued denying care to stroke patients and seniors.

Why target society's most vulnerable? A comatose patient on life support denied for lack of 'medical necessity.' A woman with Stage 3 cervical cancer initially denied because they claimed her diagnosis was 'due to an accident.' An ALS patient denied breathing equipment in her final days.

Perhaps most troubling is the timing. As Dr. Levy fought to prove his comatose patient's need for a ventilator, UnitedHealth Group's executives were being told they would 'smash financial records' this year. The company generated $16 billion in operating profits last year while hospitals spent billions fighting denials.

The frustration echoes across social media, where Dr. Levy's post about his comatose patient has now reached over thirteen million views.

As hospitals spend billions fighting denials and patients struggle for basic care, Dr. Leevy's final words resonate with a growing chorus of voices demanding change: 'Tear it all down.'