Dave Davies

He had a doctor, Edward Loftus, who put him on doses of two biologics, which are more expensive drugs because of the way they're produced. But his insurance company, United Health, scrutinized the cost. What ensued then?

He had a doctor, Edward Loftus, who put him on doses of two biologics, which are more expensive drugs because of the way they're produced. But his insurance company, United Health, scrutinized the cost. What ensued then?

He had a doctor, Edward Loftus, who put him on doses of two biologics, which are more expensive drugs because of the way they're produced. But his insurance company, United Health, scrutinized the cost. What ensued then?

Right. Even delaying care could be terribly damaging, right? That's true.

Right. Even delaying care could be terribly damaging, right? That's true.

Right. Even delaying care could be terribly damaging, right? That's true.

Yeah. There was also a moment at which UnitedHealthcare said that the doctor who had diagnosed him and had provided this elaborate and expensive treatment, that he was agreeing that a lower dose of the medication would be medically appropriate, which was simply not true, right? Yeah.

Yeah. There was also a moment at which UnitedHealthcare said that the doctor who had diagnosed him and had provided this elaborate and expensive treatment, that he was agreeing that a lower dose of the medication would be medically appropriate, which was simply not true, right? Yeah.

Yeah. There was also a moment at which UnitedHealthcare said that the doctor who had diagnosed him and had provided this elaborate and expensive treatment, that he was agreeing that a lower dose of the medication would be medically appropriate, which was simply not true, right? Yeah.

What did the United Healthcare officials say when you reach out to them for explanations? I mean, you know, you had these documents, these recordings. It must have looked terrible.

What did the United Healthcare officials say when you reach out to them for explanations? I mean, you know, you had these documents, these recordings. It must have looked terrible.

What did the United Healthcare officials say when you reach out to them for explanations? I mean, you know, you had these documents, these recordings. It must have looked terrible.

You know, you and some of your colleagues at ProPublica looked into companies whose business it is to review claims that insurance companies have been submitted for reimbursement and help decide what to pay and what not to pay. I don't know if I'm accurately stating this. One of the biggest is called Evacor. There's another one, Carillon Medical Benefits Management.

You know, you and some of your colleagues at ProPublica looked into companies whose business it is to review claims that insurance companies have been submitted for reimbursement and help decide what to pay and what not to pay. I don't know if I'm accurately stating this. One of the biggest is called Evacor. There's another one, Carillon Medical Benefits Management.

You know, you and some of your colleagues at ProPublica looked into companies whose business it is to review claims that insurance companies have been submitted for reimbursement and help decide what to pay and what not to pay. I don't know if I'm accurately stating this. One of the biggest is called Evacor. There's another one, Carillon Medical Benefits Management.

What did you find that these companies do? What role do they play?

What did you find that these companies do? What role do they play?

What did you find that these companies do? What role do they play?

Right. Now, insurance companies note that there are tests and treatments that are unnecessary or ineffective and that some unscrupulous doctors and other providers pad their income by ordering tests and treatments that they know aren't indicated. I mean, that is a real thing, right? Yeah.

Right. Now, insurance companies note that there are tests and treatments that are unnecessary or ineffective and that some unscrupulous doctors and other providers pad their income by ordering tests and treatments that they know aren't indicated. I mean, that is a real thing, right? Yeah.