UHC is bad for your health. It took me 6 months after changing to UHC to get approved for my previous therapies. I spent thousands of dollars covering Mounjaro, my insulin pump, and other expenses out of pocket because of UHC delays.

Dan is completely right. We’re just going to have AI filing prior auths to be rejected by other AI.

So my Tonal got bricked by an “update.” Now it’s just a very expensive mirror that tells me it’s checking… forever. Are we sure Tonal isn’t training for bankruptcy? 💸🔥 Feels like they’re cutting costs on customer service / software but still charging premium prices.

Healthcare for the win!

Just spit water on my keyboard laughing. Thanks Andrew Durot

When #HellthInsurance is planning to: - ⬇️ benefits - ⬆️ premiums - kick patients off of their plans —just for C suite profits— It’s making less and less sense to have a medical system based on an insurance triopoly 👉 healthcareuncovered.substack.com/p/inside-the-m… Wendell Potter HT Jacob Brody

This happens to me all the time. With Wally they send me a text if there are cancellations so I can move up my cleaning. I wish I could get this for endocrinology, rheumatology, and so much more.

Now AI has Trump Derangement Syndrome?

True story. I hate how the big PBMs operate, but to drive up the price of prescription drugs it also requires: 1. Employers continued addiction to rebates vs. lowest net price. 2. Pharma companies increasing prices to afford bigger rebates.

Well said Jacob Brody “Funny how #obesity policy is the only area where we treat long-term treatment like a luxury, cutting people off after a couple of years as if weight regain—and the health risks that follow—don’t matter.” 👉 abcnews.go.com/Health/insurer…

I hope we as a society are moving the needle on cancer incidence. I remember when we all, and still do, celebrate metformin as an "anti-cancer" drug, associated with 10% cancer reduction in the Look AHEAD trial 👉pubmed.ncbi.nlm.nih.gov/40243198/ 25-47% reduction in certain cancers

The best advisors Photon Health are all folks I’ve asked to take equity long after they’ve offered guidance, intros, or genuine support. I’d be honored if a founder told me I’ve helped enough to offer me equity one day. There’s a virtuous cycle here. Just help.

#HellthInsurance episode no. 192: “Patient’s PBM wants them to try and fail both Wegovy and Mounjaro before we can submit prior auth for Zepbound” #MakeItMakeSense

Don’t tell me there will be mocktails only. You’re serving juice.

EHRs are primarily for billing, not care. If we reformed billing MDs could focus on patient care.

Don’t Just Block Ads for Pills – Block Medicare Advantage Ads, Too, by Wendell Potter open.substack.com/pub/healthcare… #HellthInsurance

BYO Translator, that’s health equity.

Our system needs primary specialists: specialists who provide longitudinal care to people with chronic disease.

American doctors aren’t rewarded primarily for being good doctors. They’re rewarded for mastering the billing labyrinth. The physician who can recite NCCI edits, apply the right modifier, and know which codes are bundled (or can be unbundled) is the one who thrives.