Item: Peoples Health is “TRANSITIONING” to UnitedHealthcare (UHC), the results of an acquisition which actually took effect on Jan. 1, 2024.
The merger—or purchase–leaves UnitedHealthcare the largest health insurance company in the U.S. and second-largest Medicare Advantage provider in the state, was done quietly and without fanfare.
But the takeover is a potential ominous development for Peoples Health’s 63,000 members in Louisiana. Despite a pledge that “nothing will change about Peoples Health,” UnitedHealthcare’s history says differently.
But the way medical procedures are approved is changing, as one recent telephone call revealed.
UnitedHealth Group denied 16.2 percent of all standard authorization requests in 2025, about 4.8 percent higher than the industry average.
Among Medicare Advantage plans, the average denial rate is about 17.4 percent so far this year. That’s versus a national Medicare Advantage denial rate of 8.9 percent. Fully 10 percent of urgent (expedited) requests are rejected by UnitedHealthcare. On appeals, about 34.4 percent are overturned.
A U.S. Senate Permanent Subcommittee on Investigations REPORT in October 2024 indicated that the nation’s insurers, UnitedHealthcare included, have been using AI-POWERED TOOLS to deny some claims from Medicare Advantage plans holders. UnitedHealthcare’s AI model has a 90 PERCENT ERROR RATE, according to a lawsuit filed against the company. The lawsuit claims that the high error rate is not a bug in the system, but a feature of the UHC program.
A Peoples Health policy holder was recently contacted by telephone by a UnitedHealthcare representative who said referrals for treatment by most specialists must come from primary care physicians, effective Jan. 1.
Heretofore, Peoples Health has generally accepted claims from specialists without the necessity of primary care physician referrals. The exceptions are ophthalmologists and dentists.
Moreover, the primary care physician will be required to make such referrals through United HealthCare’s provider portal every six months.
In a classic repudiation of the “if-it-ain’t-broke-don’t-fix-it” dictate, that will not only require more paperwork for the primary care provider, but it will also result in critical time delays for some procedures which will initially be denied, necessitating the appeal process.
And oh, don’t be surprised, too, if your premiums are increased in the near future.
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Medicare Advantage is the worst thing that has happened to elderly healthcare. They are contributing to the decline of the system by raking out their cut from the diminishing “pot” and hurting both their policy holders and those of us on original Medicare. And their policy holders are beguiled by all the “extras” like dental and optical until they need a major procedure and hit a wall.
They are not all bad. My wife has been with Humana for over 10 years and only had one procedure denied. And it was subsequently approved. Plus several doctors have commented about how promptly procedures have been approved.
However, I do agree that those services come at a cost. I happened to be selling insurance when these products entered the Baton Rouge market. They were only available in urban parishes because they wouldn’t have been profitable in rural areas. And the companies were paid 95% of the average Medicare costs in each parish. I have not followed the industry, but apparently they have good lobbyists because they have recently paid at about 113%. That may have changed because I read a recent article about most of these plans reducing benefits, and some elimination of rural areas, for 2027.