CareMount/Optum Employee: Patient Authorization Process Outsourced to India

Outrage Mounts Over Broken Care Coordination, Fractured Call Centers

By Adam Stone

This is the 11th installment in an investigative series about CareMount/Optum, broader local healthcare issues and corporate medicine.

Within the last year or so, legacy CareMount physicians and members of the administrative leadership team met for a big company Zoom meeting, with the healthcare group’s deeply problematic phone system on the agenda.

The organization had previously hired a firm “to figure out what was wrong with phone systems,” a doctor present at the meeting told me last week.

Optum Tri-State CEO Kevin Conroy arrived with an update for the assembled group of doctors.

“The conclusion was they were not hiring 90 receptionists.” – CareMount/Optum doctor

“And so they came with their conclusion, and in a meeting, a Zoom meeting, in front of everybody, Kevin says, ‘So they came with their conclusion about what’s wrong with the phone system.’ And he says, they said, ‘We need to hire 90 more receptionists.’”

So far, so good.

But, my doctor source recounted, Conroy put the immediate kibosh on that recommended solution, perhaps restrained by higher-ups unwilling to authorize the expenditure.

“And then he said, ‘That ain’t going to happen,’” my physician source recalled the local CEO saying about the suggestion to hire more workers to coordinate patient care.

“The conclusion was they were not hiring 90 receptionists,” the doctor also told me.

Fire Hose

I had no intention of returning to CareMount/Optum/UnitedHealth coverage so soon after last week’s opus. For those who missed it, we ran a massive expose, largely built around testimony from a veteran physician about an exodus of providers, with supporting details shared by a diverse constellation of sources.

But a deluge of new information began to cascade in last week after publishing our special report, and a few of the emerging details felt too urgent to delay sharing.

• First off, an anonymous employee revealed to me that the critical work of CareMount/Optum’s pre-certification staff was recently outsourced to India, absorbed by a foreign outfit that goes by the name of IKS. The source described how radiology treatment for local patients has been severely disturbed as a result. Training of the third-party IKS personnel began about two months ago.
• Separately, a CareMount/Optum phone operator painted an ugly picture of an intensely chaotic work environment where call center agents struggle to connect with nurses due to extreme understaffing, remote work, low pay, shoddy standards and managerial tolerance or ignorance of ineptitude.
• Also, a local senior citizen shared a harrowing tale of being trapped in a bureaucratic nightmare within the CareMount/Optum phone system just last week, desperately seeking medical attention. He recounted fruitless attempts to schedule a checkup, communicate with doctors and decipher confusing test results. He’s still in limbo as of press time.
• In addition, a retired local physician discussed his time working at the organization, back when it was named Mount Kisco Medical Group, and how a profits-over-patients mentality started to take root far before Optum publicly entered the scene last year.
• Not last and not least, a current CareMount/Optum doctor – a different one than my source from last week – shed new light on a culture of fear and mismanagement while also expressing a favorable view toward unionization. Oh yeah, she also revealed how CareMount outsourced prescription services to India a few years ago, possibly risking your data privacy to this day.

All of that doesn’t even account for a ton of new reporting detail I’m forced to leave on the cutting room floor, to avoid having to write a novella length newspaper column. Although this does feel like another book chapter.

For those coming into this series for the first time now, a quick primer: Over the past year, these investigative columns have uncovered the healthcare company’s oppressive physician employment contract, a disastrous phone system, urgent care upheaval, alleged double billing, a scathing internal survey, data privacy breaches, attorney general scrutiny, suspect COVID-19 testing charges, predatory marketing tactics, Medicare Advantage-related profiteering concerns, state lobbying efforts, a disconcerting doctor shortage, the troubling mix of healthcare with insurance services, and the unethical banning of unwell patients, as well as the denial of patient medical records.

But, this week, let’s start with our headline news – the outsourcing debacle.

‘The Language Barrier Was Difficult’

To quickly define the terms, in case you’re as unfamiliar with the nature of their work as I was before last week, the pre-certification department ensures that medical procedures and treatments comply with insurance policies by verifying their necessity and eligibility before approval.

At the so-called CareMount legacy locations, across Westchester, Putnam and Dutchess counties, there are about 60 staffers performing this vital service, one of the department’s employees estimated for me.

After Optum acquired CareMount Medical, a new software system, Salesforce, was introduced to streamline the authorization process, the source explained.

News had broken in February of the company expanding its dominance through the acquisition of Crystal Run Healthcare in the lower Catskill region, bringing the neighboring organization into the Tri-State Optum group.

That medical story unfolding just north of our coverage area mirrored the shift from physician ownership to corporate ownership seen with CareMount over roughly the past two years.

CareMount’s 264 physicians sold their ownership stakes to Optum on Dec. 4, 2020, to become subordinate staff, according to a contract I obtained earlier this year.

“The morale has hit rock-bottom.” – Pre-certification staffer

(Optum Health, Optum Insight and Optum Rx are divisions of UnitedHealth Group Inc, which runs the world’s largest insurance company, UnitedHealthcare. A stunning 90,000 U.S. doctors – about 10 percent of the profession in this country – are now linked to the multinational corporation, after adding 20,000 to the ranks this year.)

But the purchase of Crystal Run also offered management an opportunity for a convenient and cunning ruse, my source within the pre-certification department revealed.

Starting in October, local employees were told to train the workers from IKS, the foreign firm.

“I got all my notes together and gave them to them because supposedly they’re going to be doing the same work I do for the OB/GYN department, they’re going to be doing that, but they’re doing it for the group called Crystal Run,” my source commented. “Okay, so then we had a Zoom call with them, and they’re from India. It’s obvious. The language barrier was difficult.”

You Can’t Handle the Truth

But the pre-certification department employee said she and her local colleagues more recently learned the apparent truth. They were training the Indian contractors to possibly replace them, potentially digging their own employment graves.

“IKS is now going to start doing radiology,” my source said she realized. “So little by little, everything that we do was being given to them to do. So now we’re at the point where pretty much everything that I do is given to them other than, say, medications or some procedures and add-ons, but eventually, if they have everything, then what’s left for us to do?”

“So that’s the thing in the back of my mind is like, how much access do they have to each individual record that they’re going into to see.” – CareMount/Optum doctor

Just three weeks ago, on Nov. 27, a manager asked staff to “please make sure to go back and check [IKS workers] are doing things correctly,” given the fact that “this is new to IKS,” according to an internal memo I reviewed.

The manager also asked in a separate message for staff to “send us a breakdown of your process and any tip/tricks,” because the company wanted to “compile one master file.”

I asked my source exactly what she believes is happening.

“We don’t know what the truth is,” she replied in a phone interview, but pointed out how many colleagues are “looking for a different job, because there isn’t transparency,” wondering whether they’ll be canned by next month, the start of the new year.

Her manager, with a long reputation for kindness and transparency, refused to directly answer persistent questions about the immediate job security of the team, replying only with vague answers about potential future staffing needs in “different modalities.”

“The morale has hit rock bottom,” the source wrote me in an earlier e-mail, before our phone interview. “Everybody is nervous, afraid they are going to be laid off. The desire to work at our usual level is very low due to the majority belief that they will probably be out of a job very soon.”

Denied

But far beyond the employment status of individual people in the local workforce, the much larger issue looms: How will this change impact quality healthcare for area patients at large?

“Well, there is more denials,” my source explained.

Urgent pre-certification requests – known as emergency “stat” requests – need to be accommodated right away.

However, IKS’ limited institutional knowledge, failure to grasp nuance, delayed responses and a host of other interconnected issues have led to new, massive, growing problems for already unsatisfied patients.

“[Pre-certification] is not being done in a timely manner,” my source said in a phone interview last week. “So what’s happening is the insurance company is not approving it, and if the patient is to move forward with the testing without the authorization, the insurance company is not going to pay for it.”

Earlier, in an e-mail exchange, the source said “prior to IKS taking over authorizations the pre-certification department at CareMount legacy was above average, in some cases exceptional.”

“The majority of the reps are knowledgeable, proficient and expedient,” she also said. “With IKS taking over the authorizations for radiology and other modalities the change is apparent. We have been bombarded with authorization denials of studies/testing not being approved due to IKS not being proficient or knowledgeable enough in what they are doing.”

As it happens, my wife’s friend is absorbing the impact of the corporate rot of pre-certification right now. She has breast cancer, and can’t break through the procedural maze to get approved, wondering in frustration last week what the heck was going on.

Now we know.

This is really bad.

“It’s not any fault of our own that it’s horrendous. It’s that we can never get in touch with a nurse because they’re understaffed.” – CareMount/Optum phone operator

Hello? Anybody There?

My phone message left for IKS on an old-fashioned voicemail machine was not returned last week, nor was an inquiry sent through the firm’s messaging portal.

A note sent to an e-mail address listed on the company’s website was not operational; I received an automated failure notice in reply.

An apparent company website says the firm focuses on “helping provider enterprises deliver better, safer and more efficient care at scale.”

Offices in Mumbai and Hyderabad, India are listed.

A pair of U.S. mailing addresses in Los Angeles and Texas are also displayed.

CareMount/Optum, for its part, stopped replying to my repeated requests for comment earlier this year.

In February, Conroy did acknowledge a host of problems in an open letter to the community.

He included the vexing phone issues in his list of planned fixes, saying the company would be “expanding and reorganizing” the call center to “make it easier to connect you with a customer service agent to schedule an appointment, refill your prescriptions or to speak to a member of our clinical team.”

No such luck.

‘Interesting’

Incredibly, the area’s legacy CareMount doctors – now just Optum employees – haven’t even been notified of the outsourcing of pre-certification staff.

In one recent internal communication I obtained, a member of the pre-certification staff asks a doctor whether they are aware that “they have outsourced the radiology to India.”

“I did not know that,” the doctor replied. “Well, that is interesting.”

Also, an internal e-mail correspondence from a pre-certification staffer details how the department is now “overwhelmed with denials and phone calls to patients and emails to MD’s.”

There are now about 75 denials per week, if not more, an exasperated employee explained in the internal communication.

“I’m just not in the position to be expelled from the group until I leave on my own terms.” – CareMount/Optum patient

“And we don’t find out until the day before (less than 48 hours) – I get yelled at all day by patients and doctors and I’m not even the one screwing it up,” a pre-certification employee is seen saying in the internal correspondence.

The author of the internal message says they are often fixing IKS’ mistakes – “which is a lot” – then submitting corrected clinical information to get problems resolved.

“I have to call patients to cancel their [appointment] because IKS gets them denied and we are only told the day before,” the local employee wrote, also noting how if they were handling the authorization process from the jump, they “wouldn’t have to do all this extra work.”

“IKS is a disaster,” the employee added.

Prescription Outsourcing

But the outsourcing of vital healthcare services is not new and predated Optum’s acquisition of the regional operation, a local CareMount doctor told me last week.

When I asked the physician about pre-certification services being shipped off to India to be performed through a third-party vendor for potentially exploitative wages, she said she had not been notified and was learning the news for the first time from me.

But she did confirm some other interconnected news: About three years ago, CareMount outsourced prescription services.

“So they’re outsourced to India and then they send us information regarding the patient and their need for a script, and we just send it out,” the physician said. “But it used to be where the nurses would get all of those. It would come in at night and the nurses would deal with them in the morning. Now they’re all outsourced.”

I asked what worries her about the prescription outsourcing.

“Basically security,” the doctor said. “That’s the thing I always think about.”

She is worried about “how much access they have to patient records.”

“So that’s the thing in the back of my mind is like, how much access do they have to each individual record that they’re going into to see,” the doctor said.

“What the patients don’t realize is, you’re not going to have any doctors anymore,” he said. “You’re going to be seeing either PAs or nurse practitioners.” – Retired pediatrician, Dr. John Costa

Call Center

I also connected last week with a phone operator who was able to provide new details about how patient care is being risked as a result of an astonishingly horrendous call center operation, resulting from corporate neglect.

Like the doctor and dozens of other sources for this series, the phone operator requested anonymity in order to speak freely and avoid what she feared could be retribution for publicly speaking out.

She described a disastrous patient care coordination system, marked by communication breakdowns and ineptitude.

“It’s not any fault of our own that it’s horrendous,” the phone operator said. “It’s that we can never get in touch with a nurse because they’re understaffed. So if we try to reach out to a nurse, let’s say the patient has an emergency, they’re basically like, ‘Oh, tell them to go to the ER.’”

But the phone operators are not clinicians. They’re prohibited from dispensing medical advice.

“So then we have to almost retell the nurse that,” the source said. “But they’re not technically even allowed to tell a patient. They have to run it through the doctor, and he has to be the one clinically to tell them. But we can’t get a nurse on the phone. So now we spend about 20 minutes trying to find a nurse. We can never find management.”

“They are under a great deal of pressure to deal with patients who need service and have waited a long time to be heard.” – Longtime patient Peter Limburg

Home Alone

I don’t know about you but I didn’t realize that any CareMount call center employees were working from home.

Keep in mind, many of these staffers are earning as little as $18 per hour, with no meaningful ongoing training, no professional development and no path for growth.

Also don’t forget that phone operators and schedulers are absolutely critical cogs in the healthcare service wheel, especially for elderly patients uncomfortable with digital communication portals.

How invested can you expect an untrained, low-paid, uninspired employee to be in coordinating our healthcare?

“We basically wing it because the only training we have to do every year is like the basic sexual harassment compliance and nothing to do with the call center,” the phone operator said in our interview last week.

Within the past year or so, an internal review concluded there should be dedicated service lines for specific medical specialties, she also shared.

“It was going to be more having the nurses and things like that, so there would be less hold time and more direction of where calls go,” the phone operator said. “But that didn’t ever happen.”

Hand-in-Hand

The inability to reach clinical staff promptly can result in delayed medical advice or delayed post-surgery follow-ups, adversely affecting patient outcomes, the source also observed.

Frustrated patients then lash out at phone operators.

“Due to not having the ability to reach the proper channels or departments, it has created issues or dissatisfaction,” the source stated in a phone interview. “Let’s just say it’s almost like we get yelled at regularly, and after the patient is able to vent, then they’ll say, ‘I know it’s not your fault.’ But we get it.”

That said, there is also a corporate ignorance or tolerance of some of the ineptitude at play.

“If you’re working there eight years, and let’s say you’re only answering 20 calls a day, and then you have other people who have been working there less years, and they’re doing 100 calls a day, but nobody seems to think, like, maybe we should retrain these people or find out what’s the slowdown,” the phone operator observed about certain colleagues. “It’s like the right hand doesn’t know what the left hand is doing.”

Some CareMount call centers are shrinking by attrition, down in staff levels by about at least 28 percent, the source said. Even when fully staffed, the volume of phone operators is about 30 percent too small, she believes, especially when factoring in some of the poor-performing personnel.

Morale is also low among phone operators because of a decrease in benefits, including a reduction in raises and the elimination of holiday bonuses, the phone operator said.

“From the nurses to the doctors to even the small people like myself, it’s frustration all around because nobody has the correct resources, manpower, and the merge with this company has actually subtracted more from the workers than it added in value,” the source said of Optum’s acquisition of CareMount. “And it’s basically just like you’re a number instead of an employee. And it’s bad because they don’t even know who is employed in their company.”

“But as with all things, greed and power can corrupt.” – Kristin Noel Raniola

Ring, Ring, Ring…Ring, Ring, Ring…

A doctor I interviewed last week spoke about how the phone system issues can negatively impact patient care to a significant degree.

Sometimes patients call, eventually reach a phone operator, but then the call doesn’t get directed into a doctor’s office.

“You call, you want to make an appointment, they send you somewhere, but half of the time the phone is ringing and it’s not ringing anywhere in our office,” the physician said.

Made aware of patients trying to reach the office, she’s searched “every phone in our pod and it’s not ringing,” also noting how she’s “sent messages [to administration] saying, ‘You need to find out where these phones are ringing.’”

But the appeals for leadership to fix the problems appear to just get ignored.

“This could be a 90-year-old lady waiting for her doctor to pick up the phone,” the local doctor told me. “She thinks he’s going to pick up. She’s holding on. Where is the phone ringing?”

Because the phone operators are low paid and have low morale, there’s also a competence factor at play, which results in delayed appointment scheduling.

“There’s this overwhelming sense of kind of being very lazy,” the doctor maintained. “The call center people are working from home still. Back in the day, if you call to make an appointment, somebody would start looking, trying to help. Nowadays they’re like, they look two months in advance, because it’s just easier.”

But the plain-speaking doctor, who said “the phone system sucks,” stressed how at the end of the day the systemic issues are “about the culture of Optum,” not a symptom of a few bad apple employees.

“I think that natural health allows people to regenerate the body using natural properties like herbs, fundamental things that we’ve kind of gotten away from.” – Dr. Kerri Stasiak

Bat Signal

A frustrated patient reached out to me last week in desperation, seeking practical help.

He simply couldn’t get through to anyone at CareMount over the phone.

After reading last week’s piece, he was curious whether I maintained some sort of backchannel way, or Batphone, to connect with medical sources.

“I was just wondering if you have, in all of your investigative reporting, if you’ve gotten any backdoors or workarounds or things that you may have picked up along the way, any tricks of the trade?” asked the patient, a local senior citizen.

My only suggestion was to visit CareMount in person, instead of call, as more and more local people report doing these days when no one picks up the phone.

One source told me about a time (equal parts amusing and damning) when she was on hold with CareMount at home on her cell phone, then drove to the local facility, and walked in to the front desk, still waiting for an operator to pick up her call.

I Did It…My Way

But even though many exhausted patients want to find new doctors outside the group, that’s easier said than done.

For instance, the local senior who contacted me last week in desperation has enjoyed a strong bond over the years with his individual CareMount doctors. As a result, he was unwilling to allow his name to be published.

“I’m just not in the position to be expelled from the group until I leave on my own terms,” he explained.

While the inability to connect over the phone with CareMount has been a long-festering problem, it became more of a crisis last week for the patient.

“The reason this is higher priority than usual is that I got some [medical] issues and they’ve taken some tests, and I can’t even get a good interpretation of what’s going on,” he said. “You can’t have a doctor that is totally walled off.”

All the Way to the Bank

At one point last week, after an hour, the local senior “finally got through to somebody,” then was disconnected after a string of transfers to the wrong departments.

“I have a feeling that there’s some sort of deliberate sabotage going on, that they just are cutting the line to free up their people, to not have to deal with the public at all,” he said.

There’s little material or practical difference between what’s actually causing the problems – a decaying, under-financed, poorly executed system characterized by malignant neglect – and the notion of “deliberate sabotage.”

On Thursday, a couple days after we connected by phone, I asked the local patient to e-mail me an update.

After several calls with wait times of up to 45 minutes, several disconnected or transferred calls dispatched to the wrong department and several patient portal communications that went unanswered, along with multiple text messages sent to his doctor’s cell phone, the patient finally received a return call from internal medicine.

Although he was able to schedule his next checkup, he said he is “still waiting for a reply from the doctor” to interpret his tests.

At the end of the day, the local patient has concluded that the “barriers between [the company] and the public” are all about expanding corporate profits.

And here’s the sobering truth: Sacrificing quality care for financial gain is working out pretty darn well for those at the top. UnitedHealth Group Inc’s market capitalization is about $500 billion, richer than many sizable countries.

Just a few generations ago, if not less, these specific issues in U.S. healthcare were essentially non-existent on any mass scale, before international corporations gained control over solo and small group operators.

On the Loose

Another insightful patient who reached out to me last week described a string of medical appointment mishaps, including double bookings and cancellations.

She speculated (correctly, as it turned out) that a surge in inexperienced remote workers likely contributes to CareMount’s deteriorating service quality.

Through her professional work, she’s observed how customer service representatives at financial companies often possess limited knowledge and frequently put her on hold to consult others when confronted with detailed questions.

“I bet Optum is in the same situation and is trying to fill positions with remote workers who are inexperienced,” she correctly guessed. “My guess is that they aren’t getting adequate training before being turned loose to do the job, and the job isn’t getting done correctly.”

In fact, all of the change in the healthcare landscape, and the related fallout, has contributed to growing calls among doctors to organize.

‘Once Upon a Time’

A retired local pediatrician, Dr. John Costa, reached out to me last week through our website’s actionable feedback portal to discuss submitting an op-ed.

He’d practiced in the Bedford Hills/Mount Kisco area for 32 years, retiring about two decades ago now because of an illness.

He’s working on truncating an essay for us called “Once Upon a Time in Medical Care.”

It’s a topic he’s passionate about, he said, given the fact that “both physicians and patients are dismayed at the industrialization of medicine and the delivery of care.”

In a subsequent phone interview, Costa expressed his concerns about the overwhelming burden on today’s physicians, with the explosion of electronic medical records, pre-certification requirements and myriad additional bureaucratic hurdles.

“What the patients don’t realize is, you’re not going to have any doctors anymore,” he said. “You’re going to be seeing either PAs (physician assistants) or nurse practitioners.”

Integrity

What I found most illuminating from my conversation with Costa was what he described about the revenue-first mentality that had creeped into CareMount’s organizational bloodstream well before the corporate takeover by Optum.

Costa worked at CareMount, back when it was called Mount Kisco Medical Group, or MKMG, starting in 1997, until about 2001. He disclosed how doctors were offered financial incentives to perform unnecessary X-rays.

“Well, some doctors would tell me they’re getting $5,000,” he said. “I was losing money for the group. After 25 years of being my own doctor, I just couldn’t order something. I would wait unless it’s really necessary.”

He would also resist the administration’s aggressive push to get him to see more patients, and spend less time with each child and their family.

“Well, initially they said, ‘Maybe you can book two every 15 minutes,’” he recalled. “And I told them, ‘I don’t think I could do that. No, I can’t practice that way.’ This is my experience.”

Union Strong?

Solutions to the systemic problems, Costa conceded, are extremely complicated. He cited the industry discussion about more doctors unionizing.

“So that’s being tossed around out there,” he said. “But we cannot go on strike. We can’t leave our patients.”

However, he said the effort is worth pursuing (while entirely removing a work stoppage from the negotiating table) to push back on the excessive paperwork demands on doctors, among a host of other concerns.

The organizing talk isn’t academic or an abstraction. Doctors at private groups, facing increased loss of autonomy and deteriorating working conditions due to healthcare mergers, are increasingly seeking unionization, for better or for worse.

For example, hundreds of physicians at the Allina Health System in Minnesota petitioned to unionize this past summer, as detailed in an Aug. 16 Bloomberg Law report.

My CareMount/Optum doctor source, for her part, agrees with the movement toward unions.

“I think that would be a great idea, especially for the younger docs coming up, because most of us have been in private practice, so we have a different frame of reference and know how things should be,” the local CareMount/Optum doctor said. “But I think unionizing would be a great thing.”

Go Ahead, Check Back Next Year

Longtime local patient Patricia Murdock highlighted the fallout from the type of corporate medicine Costa described.

She’s witnessed a disturbing pattern of disruptions in her healthcare services, including abrupt departures of multiple doctors, unavailability of alternative care options, extensive delays in scheduling essential appointments and procedures and a general lack of assistance.

Murdock stressed the urgent need for transparency, accountability and patient advocacy in the face of Optum’s apparent disregard for the well-being of the people it is tasked to help.

She had heard many months ago that her primary care physician, Dr. Dana Murphy, would be among the refugees fleeing Optum’s corporate clutches.

Ultimately, she received a letter from the company suggesting that Dr. Rene Talai, another internal medicine physician there, was available to absorb her care.

“I called, checked the scheduling portal and e-mailed, and was told that Dr. Talai was no longer taking new patients and, in any case, had no availability until 2025,” Murdock told me in an e-mail. “Optum had no suggestions aside from ‘checking back’ periodically to see if there were any new hires in 2024 who I might be able to get to take me for ongoing care.”

Little Wood Building

As I was wrapping up my reporting last week, I was hoping I could connect with a patient who had experienced most of the local medical history of the past three-quarters of a century or so, with Mount Kisco Medical Group starting as just a small shop in 1946, well before morphing into a medical monstrosity.

Serendipitously, mere minutes after that thought crossed my mind, I received an e-mail from 94-year-old local resident Peter Limburg, a longtime patient who started receiving care at the group in 1955, when he sought healthcare after his service in the Army.

When he first arrived as a patient, Limburg said Mount Kisco Medical Group was housed in a little wooden building at the corner of Main Street and South Bedford Road, with a pair of doctors and a dentist.

“During all these years we seldom had to wait more than a few weeks for an appointment, and the doctors kept some time blocked off for emergency visits,” he said.

It’s obviously a far cry from what local healthcare looks like in 2023, to put it mildly. My report last week revealed how Optum eliminated the practice of keeping same-day slots open for the suddenly sick in order to maximize profits, dispatching ill patients to urgent care to visit doctors who don’t know them.

Limburg and his wife “have stayed with it, despite increasing frustration and discontent, because we like our doctors.”

Having witnessed the evolution of the medical group since its early days, Limburg highlighted the once-efficient system that progressively declined, leading to prolonged wait times, frequent changes in assigned doctors and difficulties in accessing essential healthcare services.

He shared a disturbing story about his urologist, who was allegedly forced to retire decades ago at age 70 due to a non-compete clause.

“I repeatedly asked the MKMG staff how to reach him and was told they had no information – not true,” said Limburg, an accomplished editor and author. “Then one day they told me that he had won a lawsuit and was now practicing with a different group. You can guess where I took my business.”

These days, when he asks to speak with a clinical staff member, the best-case scenario Limburg can hope for is receiving a call back from a medical team member after 5 p.m.

“Not satisfactory,” he said.

A once high-quality local institution, Limburg now faces extended waits for critical appointments because of what he called the “abominable” phone service, and “overworked, understaffed personnel” who “take forever to pick up the phone.”

“When they do [pick up the phone],” he noted, “they speak so fast and indistinctly that I have to ask them to repeat. I can’t blame them; they are under a great deal of pressure to deal with patients who need service and have waited a long time to be heard.”

Antitrust

A separate patient relayed getting billed twice for a procedure done for her son – by two different doctors. But only one of them had treated her son.

If you want to learn more about the alleged double billing issues, and the scrutiny of CareMount’s related practices by the state Attorney General’s Office’s Health Care Bureau, read my past articles on our website.

It’s an issue I’ll likely return to with more depth by February.

That’s when the AG’s office said they’ll be releasing the next batch of digital documents from a Freedom of Information Law (FOIL) request I made in January.

But the bigger picture story here is how Optum, an alleged healthcare company, is owned by UnitedHealth, the world’s largest insurance company.

Later this week, Examiner Editor-in-Chief Martin Wilbur and I are meeting with Congressman Mike Lawler (R-Pearl River), and we will be asking the lawmaker how he might be planning to address healthcare issues for his constituents.

Last week’s piece dug deep on United’s blatant conflict of interest in plain sight, and my new doctor source keyed in on that piece of this sordid puzzle unsolicited.

“I think, first of all, allowing basically, an insurance company to monopolize medicine the way that it’s doing, because they have this little offshoot of Optum who is buying radiology places, practices, physical therapies and yet it’s owned by an insurance company, there’s a huge conflict of interest,” she said. “There should be something that says, ‘No, you can’t buy all these practices.’”

Retroactively and Arbitrarily

I lucked out in hearing last week from a provider within UnitedHealth Group’s network.

Given the conflicts of interest surrounding an organization trying to deliver healthcare and insurance services under one corporate roof, the provider’s experience struck me as highly relevant.

The source chronicled persistent concerns, including retroactive reimbursement reductions, nonstandard billing requirements, arbitrary denial of claims and a lack of transparency in benchmark rates.

To give some context, this particular provider delivers patients with a type of necessary medical treatment that must be given on a recurring basis.

Here’s an easy way to understand what goes awry for the provider: A patient receives treatment and UnitedHealth pays the patient’s January, February, April and May claims. But inexplicably, the insurance giant refuses to pay the March claim even though the March claim is identical to the others.

“UHC denies – and often just ignores – claims in a completely arbitrary manner,” the source said.  (This detail by itself warrants investigation by a national media outlet.)

The provider also recalled a scenario where UnitedHealth’s claim payment system included incorrect reimbursement rates.

“Rather than correct the reimbursement, UHC retroactively, arbitrarily and in violation of contractual obligations reduced the reimbursement rate and never paid the amount that we were entitled to as a provider,” the source said.

Lightness  

As readers of last week’s column know, I had my first appointments last Friday and Saturday with a Reiki practitioner and a naturopathic doctor respectively, as part of a personal and professional effort to gain a richer firsthand understanding of what’s missing in Western medicine, despite its breathtaking achievements.

The experiences only served to reinforce my emerging belief: A key to escaping the death grip of corporate U.S. sick care rests in our collective embrace of holistic healthcare approaches.

The details of my visits feel highly relevant to this story.

I left Reiki unquestionably lighter and in far greater balance, buzzing with positive energy. I learned about the modality, imported from Japan, after reporting last month on Northern Westchester Hospital’s growing success with integrated care.

(People live until about 85 years old in Japan on average as compared to just over 76 in the U.S.)

Kristin Noel Raniola, founder of Noelle Healing in Pound Ridge, spent an hour speaking with me on Friday before providing the treatment. The next day, I sent her a text, asking for her thoughts on the larger topic of U.S. healthcare.

She’s no hater of more conventional methods.

“I believe Western medicine is divinely created – medications that save lives, surgeons who weave through the brain and heart flawlessly, are all divinely inspired,” Raniola said. “But as with all things, greed and power can corrupt. And we see this through big pharma, etc. This has caused many to label all Western medicine as ‘bad,’ which I find totally inaccurate. Western and Eastern medicine complement each other beautifully and together create a more complete healing than when used alone.”

Amen to that.

Grandma’s Recipe 

Let me also quickly share a couple relevant details about my time with the naturopath this past Saturday.

Dr. Kerri Stasiak welcomed me into the Norwalk office herself. We then spent three hours talking. Even though I’m in good health, she wanted to get to know me on a deep level, in order to deliver ideal long-term treatment.

Stasiak detailed the science behind the proven mind-body connection.

Physical ailments often stem from mental and emotional imbalances, underscoring the importance of addressing the root causes rather than just treating symptoms, she said.

“I think that natural health allows people to regenerate the body using natural properties like herbs, fundamental things that we’ve kind of gotten away from,” Stasiak observed near the end of our session, after I asked if I could interview her for this piece. “You might look back at the past, and be like, ‘Oh, my great-grandma used to do all these home remedies that worked.’ But we’ve kind of gotten away from that in medicine.”

Earlier this year, after examining a stressed-out patient, she discovered the woman had been misdiagnosed as likely having Multiple Sclerosis. The patient’s condition significantly improved through a natural approach, targeting chronic Lyme and nervous system issues.

“She feels better than she felt on the MS drugs by helping her nervous system, talking to her about what’s going on in her life, working through therapy and different things that she’s doing now, and getting into alternative healing and stuff like that,” Stasiak remarked.

Gut Feeling

Stasiak’s practice incorporates diagnostic testing and non-invasive techniques, such as the ASYRA bioenergetic frequency machine.

The patient holds a pair of probes connected to the machine. The contraption then measures the body’s energy responses to various frequencies, providing insights into health factors such as nutrient deficiencies, pathogens and emotional stress.

While there’s certainly skeptics out there, I can only speak from firsthand experience: I was blown away by the incredible precision of the results, which appeared spot on and allowed for personalized treatment.

The body is a complex interplay of physical, mental, emotional and spiritual elements, Stasiak explained.

With that fact in mind, how could a disrespected, tense Optum doctor treat patients holistically if spending just 10 to 12 rushed minutes with people, often dispensing only cookie-cutter, insurance-endorsed prescriptions before rushing you out the door? (That dynamic is the fault of corporate demands, not flawed physicians.)

Stasiak identified how my back is misaligned – a detail no physician has ever before mentioned – and suggested physical therapy, yoga and strength training as a few avenues to better health. Additionally, the naturopath identified acupuncture as a technique my body would respond to especially well.

She also gave me a list of specific foods my body does and does not like, based on her testing, in order to decrease inflammation and improve gut health, which in turn helps brain health.

My system likes almonds, coconut and cauliflower, for example; soy, bananas and legumes not so much. Who knew?

Digestion and sleep improve for her patients immediately as a result of the insights she shares.

Incredibly, I’ve never had a physician, in 45 years, even ask me for basic details about my diet, my digestion or my bedtime habits.

Stasiak also prescribed a set of daily supplements and prepared a little homemade homeopathic witch’s brew, a concoction jam packed with natural goodies.

My energy level has surged as a result over the past 48 hours.

‘It’s Not a Business’

Although lawmakers need to try to deliver policy solutions, and courts might ultimately need to intervene on antitrust concerns, it’ll be tough to legislate or litigate our way out of this healthcare crisis.

However, perhaps us patients can change the economics by creating consumer demand for quality, holistic healthcare, including by incorporating medical bill-mitigating preventative measures – some of which can be learned just by reading.

To be clear and to state the obvious, not all large corporations are created equal. Although Amazon has earned its fair share of credible critics over the years, the company’s legendary obsession with customer satisfaction could prove transformative in healthcare.

Just last month, on Nov. 8, Amazon announced that Prime members can now experience “high-quality, convenient care from One Medical” including 24/7 on-demand virtual care nationwide and “easy-to-schedule” office visits across the United States “while saving $100 on the annual membership fee.”

That said, in the natural state of the world, good medicine involves a person in the village with vast knowledge who visits the ill, listens to their concerns for as long as it takes, diagnoses the problem and then suggests treatments.

Even if healthcare at scale in the modern world can’t quite look like this idyllic picture, mixed with the best of 21^st century advances, the current approach has veered way too far away from original principles.

There must be a happy medium.

Embracing an integrated, holistic approach does not mean abandoning the life-saving miracles of modern Western medicine.

But Optum is selling sick care slop, masquerading as medicine.

“And I had this conversation with my husband on Sunday, and I said, ‘Medicine is not a business, no matter how much they want to make it that way,’” my CareMount/Optum doctor source told me. “Medicine is not a tangible thing that we’re selling. You can’t put a price on that. It’s not a business. I don’t think that the mentality that [Optum] is bringing to the table is one that works.”

It’s too easy to forget that a profits-over-patients mentality, baked into the U.S. healthcare system cake, remains a relatively new phenomenon.

We need to figure out a way where doctors can reclaim the time they need to listen and care for patients.

Adam Stone is the publisher of Examiner Media. E-mail him with tips and feedback at astone@theexaminernews.com.