One New York City doctor shares valuable insights on how to handle health insurance companies without going to extreme measures. In the wake of the tragic shooting of a healthcare CEO, Dr. Dan Ginader emphasizes the importance of patient advocacy and provides practical ways to appeal claim denials.

Empowering Patients to Navigate Health Insurance

Use AI against them

ProPublica's report last year exposed health insurer Cigna's use of an automated algorithm that denied over 300,000 payment requests in just 1.2 seconds per case. This led to lawsuits against similar software used by other insurers like UnitedHealthcare and Humana. Dr. Ginader explains that most people don't know they have the right to appeal denied claims. Software companies like Claimable and Anamoly are now using AI to analyze data and help both payers and providers. Claimable claims an 80% success rate in overturning unjust denials within 10 days or less. Anamoly was specifically built for healthcare providers to predict insurance coverage. Its CEO, Mike Desjadon, sat down with NBC 4 Washington to explain how his company streamlines the process.

Request a peer-to-peer review

This involves getting a healthcare provider like Dr. Ginader on the phone with a human at the insurance company to discuss a patient's care. It's typically used for prior authorization approval but can also be for appeal purposes. However, the American Medical Association warns that while it can be helpful, it can also delay serious care. An AMA survey found that 24% of physicians report prior authorization led to a serious adverse event for a patient, and 94% say it increases physician burnout.

Hire an insurance lawyer

The appeal process can be complex and time-consuming, and an attorney can relieve some of the stress. Dr. Ginader has had patients resort to hiring an insurance lawyer, and they've made a difference. You can often get a consultation for a low or even no cost by using local services.

Request a fair hearing

New Yorkers pay some of the highest health insurance premiums, but the state offers social services to help. Those with public health insurance can request a fair hearing with the New York State Office of Temporary and Disability Assistance and have an administrative law judge review their case. Medicare allows you to appoint a representative like an attorney or a friend to handle the appeal. Medicare recipients also get help from the State Health Insurance Assistance Program, and every state has a Consumer Assistance Program that offers free services. In New York, the Community Service Society continues this service, and you can call 1-888-614-5400.

The United States police have made a significant arrest in the case of the killing of UnitedHealthcare CEO Brian Thompson. On Monday, New York City police commissioner Jessica Tisch announced that a 26-year-old man was taken into custody with a gun and a silencer that was "consistent" with the one used in the crime. The suspect was apprehended by officers in Altoona, Pennsylvania, which is about 375 kilometers (233 miles) west of New York City, on gun-related charges.

Unraveling the Mystery of the UnitedHealthcare CEO's Murder

Details of the Arrested Suspect

NYPD Chief of Detectives Joseph Kenny revealed that the suspect is Luigi M., who was born and raised in Maryland and has ties to San Francisco. His last known address is in Honolulu, Hawaii. The gun found on the suspect appeared to be a ghost gun, possibly manufactured using a 3D printer and capable of firing a 9 mm bullet. Luigi M. also had clothing and a mask similar to those worn by the killer, along with multiple fraudulent identifications, including a fake New Jersey ID that matched the one used by the gunman to check into a Manhattan hostel a few days before the shooting. Additionally, the suspect had a handwritten document that provided insights into his motivation and mindset. According to police, the document indicated that the suspect held "ill will toward corporate America."

This discovery has raised many questions about the suspect's background and intentions. It is clear that there is a complex web of connections and motives surrounding this tragic event.

The fact that the suspect had a ghost gun and multiple fraudulent identifications adds another layer of complexity to the case. Such weapons and documents can make it difficult for law enforcement to track and identify individuals involved in criminal activities.

The Circumstances of Thompson's Killing

Thompson was fatally shot outside a Manhattan hotel early Wednesday morning by a masked man who had apparently been waiting for his arrival. The suspect then fled the crime scene and rode a bicycle into Central Park. Surveillance video captured his exit from the park and his subsequent journey to a bus terminal in northern Manhattan, where he is believed to have taken a bus to escape.

The method of the killing and the suspect's actions after the crime suggest a premeditated and calculated act. It is evident that the killer had a specific target in mind and took steps to ensure his escape.

The ammunition found near Thompson's body, with words like "delay," "deny," and "depose," has led investigators to suspect that the gunman may have been a disgruntled employee or customer of the insurer. This raises concerns about the security and trust within the insurance industry.

Thompson had been the CEO of UnitedHealth Group's insurance unit since April 2021, with a 20-year career at the company. He was in New York for the company's annual investor conference when the tragic incident occurred.