Brian Thompson CEO of United Health Care was murdered (shot several times) by a hit man this morning on the streets in New York.

[Wrestleknownothing]

9 hours ago, Bigbrog said:

Not true at all...the company would be shut down by their states department of insurance if that is how they made their claims decisions.  Claims decisions CAN NOT be tied directly to company goals or even their policy decisions.

The New Yorker article posted earlier would suggest that there is a tension between the written rules and the practical application of those rules. It is in this area UNH seems to exist.

"Several years ago, government investigators found that UnitedHealth had used algorithms to identify mental-health-care providers who they believed were treating patients too often; these identified therapists would typically receive a call from a company “care advocate” who would question them and then cut off reimbursements. Though some states have ruled this practice illegal, it remains in play across the country. There is no single regulator for a private health-insurance company, even when it is found to be violating the law. For United’s practices to be curbed, mental-health advocates told ProPublica, every single jurisdiction in which it operates would have to successfully bring a case against it."

[1032004]

23 hours ago, billyhoyle said:

Apparently he was a high school wrestler. 

Hopefully it didn’t contribute to his back pain…

[1032004]

On 12/9/2024 at 2:05 PM, uncle bernard said:

Suspect in custody and identified. Computer Science student at PENN. Does not appear to be far left politically. You can browse his twitter for yourself. Shows concern about low birthrates, the decline of Christianity, and the "woke mind virus." Reposts a lot of fitness and mindset self-help stuff (Andrew Huberman, Tim Urban, etc...)

To me, he looks like a type of center-right, populist adjacent young male professional that is very common nowadays. Conservative cultural values combined with select anti-establishment/corporation views, but very supportive of big tech/futurist stuff (Peter Thiel for example).

https://x.com/PepMangione

I don’t believe politics really has anything to do with this murder, but fwiw here is the post he retweeted that refers to the “woke mind virus.”   It kinda reads to me like this comment is in support of the “woke mind virus” as it promotes equality.

 

[WrestlingRasta]

One question that I think can simply answer this.  If it is accurate that insurance companies are so strictly and enforceably regulated to that they must and dopayout up at least 95% of claims amounts……then why does the public claims adjusting profession even exist, and how could a public claims adjusting firm have an annual average of recuperation of 125% over initial settlement offerings?  
 

So for example, on a $90,000 insurance claim, insurance company A’s “offer”initially states the insured only has a $40,000 claim.  After many a headache with the insurance company, the insured has to hire a public claims adjuster to recoup the other $50,000, and then pay that PCA 10% to do so.  
 

If the insurance companies were making whole as described above….that scenario would not exist.  And that scenario does exist, and it exists enough for public claims adjusting to be a very profitable profession…..or side hustle. 

[jross]

Visited the EMT for my middle daughter this week.

Surgery is required.

The service provider did not quote me a price.

My price will be discovered after the insurance tells the provider what they will pay.

[Bigbrog]

55 minutes ago, WrestlingRasta said:

One question that I think can simply answer this.  If it is accurate that insurance companies are so strictly and enforceably regulated to that they must and dopayout up at least 95% of claims amounts……then why does the public claims adjusting profession even exist, and how could a public claims adjusting firm have an annual average of recuperation of 125% over initial settlement offerings?  
 

So for example, on a $90,000 insurance claim, insurance company A’s “offer”initially states the insured only has a $40,000 claim.  After many a headache with the insurance company, the insured has to hire a public claims adjuster to recoup the other $50,000, and then pay that PCA 10% to do so.  
 

If the insurance companies were making whole as described above….that scenario would not exist.  And that scenario does exist, and it exists enough for public claims adjusting to be a very profitable profession…..or side hustle. 

Well...if you are talking about subrogation of claims that is one thing; however, hiring an independent adjuster to look at your claim with no subrogation than that is another thing.  Most of the "public adjusters" are looking at subrogation of claims when the company who they have a policy through doesn't offer subrogation (think cheap insurance providers).  Subrogation is for going after OTHER insurance companies for money paid out for claims that their client was not responsible for...ex. you get into a car accident and the other driver has a different insurance company, your insurance will pay all applicable fees (repair, rental, medical - if needed), etc.) then based on an investigation, a percent at fault is determined and if the other driver is at fault for the majority of the accident then your insurance subrogation division will "go after" the other insurance company to recoup the money already paid out on the claim based on the percentage the other company is responsible for.

In addition, to your scenario above, are you wondering how a "public adjuster" is making their money or how an insurance company somehow ties their business profit goals to claims...I am confused.  Or is it some of you just want to make insurance companies that "bad guy" in every scenario??  At least be honest.

As my opinion of insurance companies...I work for a very good insurance company that does the right thing...for the most part.  However, do I understand the overall business model of insurance companies and to the general public I could see why they dislike them; however, as someone pointed out, let's see what your opinion is when you actually need one.  I'll say it again, Insurance companies make their money via investments...a lot run in the negative in terms of premium received versus amount of claims paid out...example, most companies run at 1.05 ratio which means for every $1.00 they bring in from premium they pay out $1.05 in claims.

[WrestlingRasta]

12 minutes ago, Bigbrog said:

Well...if you are talking about subrogation of claims that is one thing; however, hiring an independent adjuster to look at your claim with no subrogation than that is another thing.  Most of the "public adjusters" are looking at subrogation of claims when the company who they have a policy through doesn't offer subrogation (think cheap insurance providers).  Subrogation is for going after OTHER insurance companies for money paid out for claims that their client was not responsible for...ex. you get into a car accident and the other driver has a different insurance company, your insurance will pay all applicable fees (repair, rental, medical - if needed), etc.) then based on an investigation, a percent at fault is determined and if the other driver is at fault for the majority of the accident then your insurance subrogation division will "go after" the other insurance company to recoup the money already paid out on the claim based on the percentage the other company is responsible for.

In addition, to your scenario above, are you wondering how a "public adjuster" is making their money or how an insurance company somehow ties their business profit goals to claims...I am confused.  Or is it some of you just want to make insurance companies that "bad guy" in every scenario??  At least be honest.

As my opinion of insurance companies...I work for a very good insurance company that does the right thing...for the most part.  However, do I understand the overall business model of insurance companies and to the general public I could see why they dislike them; however, as someone pointed out, let's see what your opinion is when you actually need one.  I'll say it again, Insurance companies make their money via investments...a lot run in the negative in terms of premium received versus amount of claims paid out...example, most companies run at 1.05 ratio which means for every $1.00 they bring in from premium they pay out $1.05 in claims.

I will try to make my point without a whole lot of words, and I am not talking about subrogation in any shape or form.  There is no third party who caused the loss/damage in the scenario I wrote about, I have no idea where you even got subrogation.

The PCA profession exists, because insurance companies on a very regular basis short what insured's having coming to them in terms of insurance claims.  They exist because insured's get frustrated, so they have to higher a professional to fight for them and recoup what they have coming due to their policy.  If the insurance company is paying the claim appropriately, there is no need for the PCA.   The fact that there is so much of a need for PCA's, shows that on a regular basis insurance companies are trying to short change what they owe on a claim settlement. 

Hopefully that's a little more clear.

 

Edited December 11 by WrestlingRasta

[Bigbrog]

54 minutes ago, WrestlingRasta said:

I will try to make my point without a whole lot of words, and I am not talking about subrogation in any shape or form.  There is no third party who caused the loss/damage in the scenario I wrote about, I have no idea where you even got subrogation.

The PCA profession exists, because insurance companies on a very regular basis short what insured's having coming to them in terms of insurance claims.  They exist because insured's get frustrated, so they have to higher a professional to fight for them and recoup what they have coming due to their policy.  If the insurance company is paying the claim appropriately, there is no need for the PCA.   The fact that there is so much of a need for PCA's, shows that on a regular basis insurance companies are trying to short change what they owe on a claim settlement. 

Hopefully that's a little more clear.

 

Which insurance companies (specifically) do PCA's get hired to go after the most?  Answer you will never be able to find out this information.  Thus, your statement about insurance companies regularly short changing customers is just that...a statement.  If your opinion is based on because there are PCA's in the first place than have at it because it isn't based in reality.  My opinion and experience is that they exist to work on the fringes of one-off scenarios, and not to address an overall systemic issue of the big bad insurance companies screwing over their customers.

[WrestlingRasta]

2 minutes ago, Bigbrog said:

Which insurance companies (specifically) do PCA's get hired to go after the most?  Answer you will never be able to find out this information.  Thus, your statement about insurance companies regularly short changing customers is just that...a statement.  If your opinion is based on because there are PCA's in the first place than have at it because it isn't based in reality.  My opinion and experience is that they exist to work on the fringes of one-off scenarios, and not to address an overall systemic issue of the big bad insurance companies screwing over their customers.

So you're one of those that believes your experience covers everyone's experience.   Good information to have in discussing things with you.

 

But back to the point, yes.....you can find this information.  Many of the PCA firms keep this information from their own data.   My statement is a statement with and industry full of backing, whether that is your experience or not.  

[Bigbrog]

3 minutes ago, WrestlingRasta said:

So you're one of those that believes your experience covers everyone's experience.   Good information to have in discussing things with you.

 

But back to the point, yes.....you can find this information.  Many of the PCA firms keep this information from their own data.   My statement is a statement with and industry full of backing, whether that is your experience or not.  

When did I say it was my personal experience??  I am telling you the experience of being in the industry...and having worked at revamping a fortune 300 insurance companies claims processes and operating model for 7 years I have a pretty good idea of what does and doesn't happen in the industry.

And if the information you claim is easy to access, please do share as it is not required to document and share this information from regulatory standpoint.  I can tell you that no one that I worked with in claims (those who have 30+ years in the industry) have ever had to deal with a public claims adjuster...again it may have happened, but it had to have been a one-off situation that was not a big deal because no one ever remembered dealing with it.

[WrestlingRasta]

8 minutes ago, Bigbrog said:

When did I say it was my personal experience??  I am telling you the experience of being in the industry...

I guess if you need more of an answer than you gave yourself, it would be when you said "My opinion and experience is that...."

Edited December 11 by WrestlingRasta

[WrestlingRasta]

Look up my state and there are currrently 175,000 public adjusters licensed in Florida.   Must be a lot of one-offs.  I know a PCA that made $325,000 last year.   He makes 10% of what he recuperates from the insurance company in a claim, above their initial offer.  That means just this one person was able to recoup 3.2 million dollars, in one year, that insurance companies were trying to short in their claim settlements.    

That's a whole lot of one-offs, for just one singular PCA.

[uncle bernard]

12 hours ago, 1032004 said:

I don’t believe politics really has anything to do with this murder, but fwiw here is the post he retweeted that refers to the “woke mind virus.”   It kinda reads to me like this comment is in support of the “woke mind virus” as it promotes equality.

 

Yeah.....sure.

"The levelers want to destroy everything because in the rubble we will all be equal."

[Bigbrog]

37 minutes ago, WrestlingRasta said:

Look up my state and there are currrently 175,000 public adjusters licensed in Florida.   Must be a lot of one-offs.  I know a PCA that made $325,000 last year.   He makes 10% of what he recuperates from the insurance company in a claim, above their initial offer.  That means just this one person was able to recoup 3.2 million dollars, in one year, that insurance companies were trying to short in their claim settlements.    

That's a whole lot of one-offs, for just one singular PCA.

I looked up the top insurers (homeowners) in FL for 2024 and through the first quarter of the year (Residential Market Share Reports), as expected, they are obscure/smaller insurance companies (there was one of the biggies, state farm, but I believe they brokerage FL policies).  This may explain what you presented above (I am taking your word for it in terms of the numbers you are reporting here)...most if not all of the smaller/obscure insurers sub out their claims process and those adjusters don't have any vested interest in the company or the insured; thus, more often than not aren't doing a quality job adjusting the claims.  The company I work for did a project looking at our contingent claims adjuster spend versus their claim's accuracy (my employee led the effort) and we drastically reduced the amount of contingent adjusters due to their inability to meet SLA's and their claim accuracy (both overpaying and underpaying) and we saved millions of dollars by doing so and were able to revamp our claims process to account for the additional claims all the while drastically increasing claims accuracy and reducing litigated and/or challenged claims.

I am done with the back and forth...I know I won't change your mind no matter how much I explain how the real world of insurance works, you have your anecdotal "experiences" and are going to stick with that.

Sorry for boring everyone with my back and forth and technical insurance claims "stuff".  Bottom line is NO ONE deserves to be gunned down for working for an insurance companies and Insurance companies CAN NOT base their claims practices and policies on their corporate financial goals.

[1032004]

2 minutes ago, uncle bernard said:

Yeah.....sure.

"The levelers want to destroy everything because in the rubble we will all be equal."

It’s not clear to me who that poster is referring to as “the levelers”

[WrestlingRasta]

1 minute ago, Bigbrog said:

I looked up the top insurers (homeowners) in FL for 2024 and through the first quarter of the year (Residential Market Share Reports), as expected, they are obscure/smaller insurance companies (there was one of the biggies, state farm, but I believe they brokerage FL policies).  This may explain what you presented above (I am taking your word for it in terms of the numbers you are reporting here)...most if not all of the smaller/obscure insurers sub out their claims process and those adjusters don't have any vested interest in the company or the insured; thus, more often than not aren't doing a quality job adjusting the claims.  The company I work for did a project looking at our contingent claims adjuster spend versus their claim's accuracy (my employee led the effort) and we drastically reduced the amount of contingent adjusters due to their inability to meet SLA's and their claim accuracy (both overpaying and underpaying) and we saved millions of dollars by doing so and were able to revamp our claims process to account for the additional claims all the while drastically increasing claims accuracy and reducing litigated and/or challenged claims.

I am done with the back and forth...I know I won't change your mind no matter how much I explain how the real world of insurance works, you have your anecdotal "experiences" and are going to stick with that.

Sorry for boring everyone with my back and forth and technical insurance claims "stuff".  Bottom line is NO ONE deserves to be gunned down for working for an insurance companies and Insurance companies CAN NOT base their claims practices and policies on their corporate financial goals.

Taking the scenarios I’m laying out, coming up with something different, and saying “I think this is what you are talking about” does not change the reality.  
 

Bottom line, insurance companies regularly attempt to pay less than they are obligated to pay under contract, to the point that there is a whole, very lucrative profession on the sole purpose of fighting for the insured when they are not paid what they are due. There are literally thousands upon thousands of people making a very good living by fighting for and collecting what the insurance companies owe, after they’ve denied full or partial payment of claim.

[Bigbrog]

13 minutes ago, WrestlingRasta said:

Taking the scenarios I’m laying out, coming up with something different, and saying “I think this is what you are talking about” does not change the reality.  
 

Bottom line, insurance companies regularly attempt to pay less than they are obligated to pay under contract, to the point that there is a whole, very lucrative profession on the sole purpose of fighting for the insured when they are not paid what they are due. There are literally thousands upon thousands of people making a very good living by fighting for and collecting what the insurance companies owe, after they’ve denied full or partial payment of claim.

[mspart]

Luigi is fighting extradition to NY.   So far his attorney has said he sees nothing that indicates he should be extradited. 

mspart

[wrestlingguy]

1 hour ago, WrestlingRasta said:

I know a PCA that made $325,000 last year.   He makes 10% of what he recuperates from the insurance company in a claim, above their initial offer.  That means just this one person was able to recoup 3.2 million dollars, in one year, that insurance companies were trying to short in their claim settlements.    

Any idea if you need a JD to do this job? I am a pro at pestering people for the good of man and could use that type of $$.

[uncle bernard]

48 minutes ago, 1032004 said:

It’s not clear to me who that poster is referring to as “the levelers”

Probably the people who want to "level" society aka make it equal aka woke people. 

[Tripnsweep]

I wonder if he makes it to trial or if somebody Jack Ruby's him before he gets there. 

[mspart]

Oooh, the thick plottens. 

mspart

[Caveira]

54 minutes ago, mspart said:

Oooh, the thick plottens. 

mspart

There were / are rumors (prolly unfounded) he was going to be testifying against a lot of the insider trading whackos like pelosi and company.   

[1032004]

3 hours ago, uncle bernard said:

Probably the people who want to "level" society aka make it equal aka woke people. 

Ok you’re right that guy (who Luigi retweeted) is anti-woke.  Sorry was unable to decipher that other tweet

 

[jross]

CNN says Luigi's been charged with second-degree murder, which could mean 15 years to life if he's found guilty.

New York has been wrong since 2004.   The final, fitting punishment for murder is swift capital punishment.

https://www.cnn.com/2024/12/13/us/luigi-mangione-brian-thompson-ceo/index.html