Noel C. Scidmore's Blog
June 24, 2020
Health Insurance Company's financials
My book, Mortal Conspiracy is about the woes of the American health insurance industry. In 2019, the largest health related company in the world was UnitedHealth Group. One arm of UnitedHealth Group is UnitedHealth Insurance, which also happens to be the world’s largest private for-profit health insurance company. The other arm of UnitedHealth Group is called Optum, which comprises 4 other non-insurance healthcare companies. As a total, UnitedHealth Group had a 2019 gross income of $242.2 Billion, which was a 7% increase from 2018. Their net income was $13.84 Billion, which was a 15.46% increase from 2018. The corporate officers of the company are well paid. In 2017, UnitedHealth Group had 2 CEO’s run the company. One CEO ran the company for 8 months before accepting a different position with the company. The second CEO worked for 4 months. Between salaries and exercising stock options, UnitedHealth Group paid these 2 CEO’s a total of $110 million.
How does UnitedHealth Group remain so profitable year after year? They take a hard negotiating stance with the physician groups that provide care to their insured patients. In the last year, they have abruptly canceled contracts with multiple physician groups, hoping to reduce their compensation for services provided. They also deny claims when patients have undergone certain tests or treatments. They also have increased the requirement for pre-authorization of tests and treatments from doctor’s offices who are taking care of their patients.
I would like to say that UnitedHealth Group is alone in this type of income revenue and CEO salaries. I’m afraid that’s not the case. In future blogs, I will discuss other companies and their business practices, to let the public know what is happening in the American healthcare industry.
WORK CITED:
My book, Mortal Conspiracy is about the woes of the American health insurance industry. In 2019, the largest health related company in the world was UnitedHealth Group. One arm of UnitedHealth Group is UnitedHealth Insurance, which also happens to be the world’s largest private for-profit health insurance company. The other arm of UnitedHealth Group is called Optum, which comprises 4 other non-insurance healthcare companies. As a total, UnitedHealth Group had a 2019 gross income of $242.2 Billion, which was a 7% increase from 2018. Their net income was $13.84 Billion, which was a 15.46% increase from 2018. The corporate officers of the company are well paid. In 2017, UnitedHealth Group had 2 CEO’s run the company. One CEO ran the company for 8 months before accepting a different position with the company. The second CEO worked for 4 months. Between salaries and exercising stock options, UnitedHealth Group paid these 2 CEO’s a total of $110 million.
How does UnitedHealth Group remain so profitable year after year? They take a hard negotiating stance with the physician groups that provide care to their insured patients. In the last year, they have abruptly canceled contracts with multiple physician groups, hoping to reduce their compensation for services provided. They also deny claims when patients have undergone certain tests or treatments. They also have increased the requirement for pre-authorization of tests and treatments from doctor’s offices who are taking care of their patients.
I would like to say that UnitedHealth Group is alone in this type of income revenue and CEO salaries. I’m afraid that’s not the case. In future blogs, I will discuss other companies and their business practices, to let the public know what is happening in the American healthcare industry.
WORK CITED:
How does UnitedHealth Group remain so profitable year after year? They take a hard negotiating stance with the physician groups that provide care to their insured patients. In the last year, they have abruptly canceled contracts with multiple physician groups, hoping to reduce their compensation for services provided. They also deny claims when patients have undergone certain tests or treatments. They also have increased the requirement for pre-authorization of tests and treatments from doctor’s offices who are taking care of their patients.
I would like to say that UnitedHealth Group is alone in this type of income revenue and CEO salaries. I’m afraid that’s not the case. In future blogs, I will discuss other companies and their business practices, to let the public know what is happening in the American healthcare industry.
WORK CITED:
My book, Mortal Conspiracy is about the woes of the American health insurance industry. In 2019, the largest health related company in the world was UnitedHealth Group. One arm of UnitedHealth Group is UnitedHealth Insurance, which also happens to be the world’s largest private for-profit health insurance company. The other arm of UnitedHealth Group is called Optum, which comprises 4 other non-insurance healthcare companies. As a total, UnitedHealth Group had a 2019 gross income of $242.2 Billion, which was a 7% increase from 2018. Their net income was $13.84 Billion, which was a 15.46% increase from 2018. The corporate officers of the company are well paid. In 2017, UnitedHealth Group had 2 CEO’s run the company. One CEO ran the company for 8 months before accepting a different position with the company. The second CEO worked for 4 months. Between salaries and exercising stock options, UnitedHealth Group paid these 2 CEO’s a total of $110 million.
How does UnitedHealth Group remain so profitable year after year? They take a hard negotiating stance with the physician groups that provide care to their insured patients. In the last year, they have abruptly canceled contracts with multiple physician groups, hoping to reduce their compensation for services provided. They also deny claims when patients have undergone certain tests or treatments. They also have increased the requirement for pre-authorization of tests and treatments from doctor’s offices who are taking care of their patients.
I would like to say that UnitedHealth Group is alone in this type of income revenue and CEO salaries. I’m afraid that’s not the case. In future blogs, I will discuss other companies and their business practices, to let the public know what is happening in the American healthcare industry.
WORK CITED:
True Story
Blog about the book, Mortal Conspiracy.
As a physician specializing in radiation oncology in private practice in Tallahassee, Florida, I had many difficult interactions with health insurance companies and health maintenance companies(HMO’s). The events surrounding one particular patient were extreme enough that I felt a moral obligation to write my first novel, Mortal Conspiracy, that focuses on the predatory practices that some HMO’s and health insurance companies engage in.
In July of 1995, I saw a 56 year old woman with advanced lung cancer that had spread to the lymph nodes of the chest and neck and multiple bony sites in the spine and ribs. Her presenting symptom was back pain. With her type of lung cancer, chemotherapy was not advised, but palliative(non-curative) radiation therapy standard recommendation. Given the extent of her cancer, I explained the the patient and her husband that her lifespan was approximately 6 months.
Shockingly, her cancer melted away with the radiation, and her pain went away. Unfortunately, she had a severe recurrence of pain in her back 8 months after I initially saw her, or 6 1/2 months since completing her radiation. Radiation can only be given once to a given site due to the risks of severe damage, so I was forced to admit her to the hospital to try and control her pain with medications.
After 4 days in the hospital with progressive increases in her pain medication regimen her pain was still severe.The pain specialist that I consulted to see my patient and I agreed that the only option to control her pain was an epidural catheter, which is a thin tube threaded into the spine. The pain medication is then attached to the catheter by a pump to carefully deliver an accurate dose of pain medicine. On her 6th hospital day, as the pain specialist prepared to place the catheter, my patient’s HMO served her with an immediate order with denial of the epidural catheter.
I dropped everything I was involved in and called the Chief Executive Officer(CEO), the Chief Operating Officer(COO), and the Utilization Review nurse of the HMO. Only the nurse called me back. She said that my patient could stay in the hospital, but the HMO would no longer pay for her care. Multiple phone calls to the CEO and COO went unreturned.
Given the severity of my patient’s pain and the fact that the high doses of pain medicine she was on could cause a fatal overdose, I wrote an urgent letter to the State Health Insurance Commissioner, whose office was in Tallahassee. I hand delivered it to him on the day that my patient was discharged. I copied all of the doctors on the case. Suddenly, 4 days later, I got a call from the COO of the HMO. He informed me that the CEO refused the request for the epidural catheter. I made it clear to him that the catheter was the “standard of care” in this situation, meaning that federal regulations existed that stipulated that all health insurance companies and HMS’s were legally bound to provide the care that I had requested. `
As the administrators and I went back and forth, I took it upon myself to educate myself about this HMO. The company had been started by a large number of doctors in Tallahassee as a private company. For some unknown reason, the doctors sold the company. When the new management took over, The CEO took $30 million for himself. Many doctors in Tallahassee were offered stock in the company at low prices as a financial incentive to keep utilization and hence costs down.
As I got several refusals for my patient’s epidural catheter from a group of physicians that made up something known as a “Utilization Review Committee”, which decides on whether hospitalizations or procedures will be approved by the HMO, I discovered the nearly all of the physicians had significant stock holdings in the committee. I continued to press the other doctors involved in my patient’s care and the State Insurance Commissioner to intervene for my patient. Given that the epidural catheter was the “standard of care” in this situation and the fact that I hadn’t given up, The HMO realized that the could be sued for denial of appropriate care. 10 days from my patient’s discharge, the HMO gave approval of the catheter, but I was not allowed to admit her. She lived 3 1/2 months out of pain and without the severe sleepiness she experienced by her other pain regimen.
After my patient was taken care of, I received a letter from the HMO threatening “to punish me for argumentative and disputative behavior”. All of the doctors on the case were sent a copy of the letter, and I was made aware that many physicians on the Utilization Review were in favor of punishing me. This was all in an attempt on ruining my reputation. What they didn’t count on was that many doctors involved in the case came forward and supported me. It is notable that in 2001, 5 years later, I was nominated as “Physician of the Year” by the patients of Tallahassee. My practice grew continuously following the event, demonstrating to me that caring for and about patients is always the correct path.
As a physician specializing in radiation oncology in private practice in Tallahassee, Florida, I had many difficult interactions with health insurance companies and health maintenance companies(HMO’s). The events surrounding one particular patient were extreme enough that I felt a moral obligation to write my first novel, Mortal Conspiracy, that focuses on the predatory practices that some HMO’s and health insurance companies engage in.
In July of 1995, I saw a 56 year old woman with advanced lung cancer that had spread to the lymph nodes of the chest and neck and multiple bony sites in the spine and ribs. Her presenting symptom was back pain. With her type of lung cancer, chemotherapy was not advised, but palliative(non-curative) radiation therapy standard recommendation. Given the extent of her cancer, I explained the the patient and her husband that her lifespan was approximately 6 months.
Shockingly, her cancer melted away with the radiation, and her pain went away. Unfortunately, she had a severe recurrence of pain in her back 8 months after I initially saw her, or 6 1/2 months since completing her radiation. Radiation can only be given once to a given site due to the risks of severe damage, so I was forced to admit her to the hospital to try and control her pain with medications.
After 4 days in the hospital with progressive increases in her pain medication regimen her pain was still severe.The pain specialist that I consulted to see my patient and I agreed that the only option to control her pain was an epidural catheter, which is a thin tube threaded into the spine. The pain medication is then attached to the catheter by a pump to carefully deliver an accurate dose of pain medicine. On her 6th hospital day, as the pain specialist prepared to place the catheter, my patient’s HMO served her with an immediate order with denial of the epidural catheter.
I dropped everything I was involved in and called the Chief Executive Officer(CEO), the Chief Operating Officer(COO), and the Utilization Review nurse of the HMO. Only the nurse called me back. She said that my patient could stay in the hospital, but the HMO would no longer pay for her care. Multiple phone calls to the CEO and COO went unreturned.
Given the severity of my patient’s pain and the fact that the high doses of pain medicine she was on could cause a fatal overdose, I wrote an urgent letter to the State Health Insurance Commissioner, whose office was in Tallahassee. I hand delivered it to him on the day that my patient was discharged. I copied all of the doctors on the case. Suddenly, 4 days later, I got a call from the COO of the HMO. He informed me that the CEO refused the request for the epidural catheter. I made it clear to him that the catheter was the “standard of care” in this situation, meaning that federal regulations existed that stipulated that all health insurance companies and HMS’s were legally bound to provide the care that I had requested. `
As the administrators and I went back and forth, I took it upon myself to educate myself about this HMO. The company had been started by a large number of doctors in Tallahassee as a private company. For some unknown reason, the doctors sold the company. When the new management took over, The CEO took $30 million for himself. Many doctors in Tallahassee were offered stock in the company at low prices as a financial incentive to keep utilization and hence costs down.
As I got several refusals for my patient’s epidural catheter from a group of physicians that made up something known as a “Utilization Review Committee”, which decides on whether hospitalizations or procedures will be approved by the HMO, I discovered the nearly all of the physicians had significant stock holdings in the committee. I continued to press the other doctors involved in my patient’s care and the State Insurance Commissioner to intervene for my patient. Given that the epidural catheter was the “standard of care” in this situation and the fact that I hadn’t given up, The HMO realized that the could be sued for denial of appropriate care. 10 days from my patient’s discharge, the HMO gave approval of the catheter, but I was not allowed to admit her. She lived 3 1/2 months out of pain and without the severe sleepiness she experienced by her other pain regimen.
After my patient was taken care of, I received a letter from the HMO threatening “to punish me for argumentative and disputative behavior”. All of the doctors on the case were sent a copy of the letter, and I was made aware that many physicians on the Utilization Review were in favor of punishing me. This was all in an attempt on ruining my reputation. What they didn’t count on was that many doctors involved in the case came forward and supported me. It is notable that in 2001, 5 years later, I was nominated as “Physician of the Year” by the patients of Tallahassee. My practice grew continuously following the event, demonstrating to me that caring for and about patients is always the correct path.
True facts inspiring the writing of Mortal Conspiracy
Blog about the book, Mortal Conspiracy.
As a physician specializing in radiation oncology in private practice in Tallahassee, Florida, I had many difficult interactions with health insurance companies and health maintenance companies(HMO’s). The events surrounding one particular patient were extreme enough that I felt a moral obligation to write my first novel, Mortal Conspiracy, that focuses on the predatory practices that some HMO’s and health insurance companies engage in.
In July of 1995, I saw a 56 year old woman with advanced lung cancer that had spread to the lymph nodes of the chest and neck and multiple bony sites in the spine and ribs. Her presenting symptom was back pain. With her type of lung cancer, chemotherapy was not advised, but palliative(non-curative) radiation therapy standard recommendation. Given the extent of her cancer, I explained the the patient and her husband that her lifespan was approximately 6 months.
Shockingly, her cancer melted away with the radiation, and her pain went away. Unfortunately, she had a severe recurrence of pain in her back 8 months after I initially saw her, or 6 1/2 months since completing her radiation. Radiation can only be given once to a given site due to the risks of severe damage, so I was forced to admit her to the hospital to try and control her pain with medications.
After 4 days in the hospital with progressive increases in her pain medication regimen her pain was still severe.The pain specialist that I consulted to see my patient and I agreed that the only option to control her pain was an epidural catheter, which is a thin tube threaded into the spine. The pain medication is then attached to the catheter by a pump to carefully deliver an accurate dose of pain medicine. On her 6th hospital day, as the pain specialist prepared to place the catheter, my patient’s HMO served her with an immediate order with denial of the epidural catheter.
I dropped everything I was involved in and called the Chief Executive Officer(CEO), the Chief Operating Officer(COO), and the Utilization Review nurse of the HMO. Only the nurse called me back. She said that my patient could stay in the hospital, but the HMO would no longer pay for her care. Multiple phone calls to the CEO and COO went unreturned.
Given the severity of my patient’s pain and the fact that the high doses of pain medicine she was on could cause a fatal overdose, I wrote an urgent letter to the State Health Insurance Commissioner, whose office was in Tallahassee. I hand delivered it to him on the day that my patient was discharged. I copied all of the doctors on the case. Suddenly, 4 days later, I got a call from the COO of the HMO. He informed me that the CEO refused the request for the epidural catheter. I made it clear to him that the catheter was the “standard of care” in this situation, meaning that federal regulations existed that stipulated that all health insurance companies and HMS’s were legally bound to provide the care that I had requested. `
As the administrators and I went back and forth, I took it upon myself to educate myself about this HMO. The company had been started by a large number of doctors in Tallahassee as a private company. For some unknown reason, the doctors sold the company. When the new management took over, The CEO took $30 million for himself. Many doctors in Tallahassee were offered stock in the company at low prices as a financial incentive to keep utilization and hence costs down.
As I got several refusals for my patient’s epidural catheter from a group of physicians that made up something known as a “Utilization Review Committee”, which decides on whether hospitalizations or procedures will be approved by the HMO, I discovered the nearly all of the physicians had significant stock holdings in the committee. I continued to press the other doctors involved in my patient’s care and the State Insurance Commissioner to intervene for my patient. Given that the epidural catheter was the “standard of care” in this situation and the fact that I hadn’t given up, The HMO realized that the could be sued for denial of appropriate care. 10 days from my patient’s discharge, the HMO gave approval of the catheter, but I was not allowed to admit her. She lived 3 1/2 months out of pain and without the severe sleepiness she experienced by her other pain regimen.
After my patient was taken care of, I received a letter from the HMO threatening “to punish me for argumentative and disputative behavior”. All of the doctors on the case were sent a copy of the letter, and I was made aware that many physicians on the Utilization Review were in favor of punishing me. This was all in an attempt on ruining my reputation. What they didn’t count on was that many doctors involved in the case came forward and supported me. It is notable that in 2001, 5 years later, I was nominated as “Physician of the Year” by the patients of Tallahassee. My practice grew continuously following the event, demonstrating to me that caring for and about patients is always the correct path.
As a physician specializing in radiation oncology in private practice in Tallahassee, Florida, I had many difficult interactions with health insurance companies and health maintenance companies(HMO’s). The events surrounding one particular patient were extreme enough that I felt a moral obligation to write my first novel, Mortal Conspiracy, that focuses on the predatory practices that some HMO’s and health insurance companies engage in.
In July of 1995, I saw a 56 year old woman with advanced lung cancer that had spread to the lymph nodes of the chest and neck and multiple bony sites in the spine and ribs. Her presenting symptom was back pain. With her type of lung cancer, chemotherapy was not advised, but palliative(non-curative) radiation therapy standard recommendation. Given the extent of her cancer, I explained the the patient and her husband that her lifespan was approximately 6 months.
Shockingly, her cancer melted away with the radiation, and her pain went away. Unfortunately, she had a severe recurrence of pain in her back 8 months after I initially saw her, or 6 1/2 months since completing her radiation. Radiation can only be given once to a given site due to the risks of severe damage, so I was forced to admit her to the hospital to try and control her pain with medications.
After 4 days in the hospital with progressive increases in her pain medication regimen her pain was still severe.The pain specialist that I consulted to see my patient and I agreed that the only option to control her pain was an epidural catheter, which is a thin tube threaded into the spine. The pain medication is then attached to the catheter by a pump to carefully deliver an accurate dose of pain medicine. On her 6th hospital day, as the pain specialist prepared to place the catheter, my patient’s HMO served her with an immediate order with denial of the epidural catheter.
I dropped everything I was involved in and called the Chief Executive Officer(CEO), the Chief Operating Officer(COO), and the Utilization Review nurse of the HMO. Only the nurse called me back. She said that my patient could stay in the hospital, but the HMO would no longer pay for her care. Multiple phone calls to the CEO and COO went unreturned.
Given the severity of my patient’s pain and the fact that the high doses of pain medicine she was on could cause a fatal overdose, I wrote an urgent letter to the State Health Insurance Commissioner, whose office was in Tallahassee. I hand delivered it to him on the day that my patient was discharged. I copied all of the doctors on the case. Suddenly, 4 days later, I got a call from the COO of the HMO. He informed me that the CEO refused the request for the epidural catheter. I made it clear to him that the catheter was the “standard of care” in this situation, meaning that federal regulations existed that stipulated that all health insurance companies and HMS’s were legally bound to provide the care that I had requested. `
As the administrators and I went back and forth, I took it upon myself to educate myself about this HMO. The company had been started by a large number of doctors in Tallahassee as a private company. For some unknown reason, the doctors sold the company. When the new management took over, The CEO took $30 million for himself. Many doctors in Tallahassee were offered stock in the company at low prices as a financial incentive to keep utilization and hence costs down.
As I got several refusals for my patient’s epidural catheter from a group of physicians that made up something known as a “Utilization Review Committee”, which decides on whether hospitalizations or procedures will be approved by the HMO, I discovered the nearly all of the physicians had significant stock holdings in the committee. I continued to press the other doctors involved in my patient’s care and the State Insurance Commissioner to intervene for my patient. Given that the epidural catheter was the “standard of care” in this situation and the fact that I hadn’t given up, The HMO realized that the could be sued for denial of appropriate care. 10 days from my patient’s discharge, the HMO gave approval of the catheter, but I was not allowed to admit her. She lived 3 1/2 months out of pain and without the severe sleepiness she experienced by her other pain regimen.
After my patient was taken care of, I received a letter from the HMO threatening “to punish me for argumentative and disputative behavior”. All of the doctors on the case were sent a copy of the letter, and I was made aware that many physicians on the Utilization Review were in favor of punishing me. This was all in an attempt on ruining my reputation. What they didn’t count on was that many doctors involved in the case came forward and supported me. It is notable that in 2001, 5 years later, I was nominated as “Physician of the Year” by the patients of Tallahassee. My practice grew continuously following the event, demonstrating to me that caring for and about patients is always the correct path.
