Mulgrew basically threw a shark into a baby pool. What is the matter with him?... An Active Delegate
Speaking of sharks, I can't wait to get to that herring in cream sauce. I invited a non-Jewish friend over to observe how Jews eat dairy after a fast. Reading the piece below, my hunger only helps me get more pissed off - and not only at the Unity gang, who act like they have for 60 years - new faces, old places.
Thursday, Oct. 2, 2025
Daniel Alicea has been doing the work that others should have been doing. I sat next to him at the DA on Monday and he kept muttering all meeting about the flaws, while surrounding Unity gang shushed us when I tried to get exactly what he was saying. And when I got home I realized that after hearing the Unity cheers and dancing in the aisles after RTC Chapter Leader Bennett Fischer voted YES without consulting his chapter or even the 300 delegates elected with him, I realized what damage that vote may cause.
But I get it - a consistent mentality. on the part of a segment of the opposition over decades that wants to try to play nice with Unity -- reminds me of the current leadership of the Democratic Party always trying to play nice with the Republicans and not wanting to see them as enemies, just like to these oppo people Unity is not an enemy of democracy and the way they run the union, actually anti-union. But you know what? If another issue came up the same people will do the same thing. They never learn.
They want us to focus on Trump and ally with a union leadership that has been part and parcel of the weak Democratic Party leadership that has helped bring us Trump. Yes, Randi resigned recently and Mulgrew endorsed Mamdani but keep a close eye on them and see a union leadership that strives to save the city money on our backs has really changed.
I admit to not doing that work that Daniel and so many others had been doing in the ABC chats since the Aug. 28 first healthcare committee meeting and for that they've been attacked by the Unity lites. But I am acting under the assumption not to trust the union leadership to present things in an honest way. So I was an automatic NO, especially considering the lies and misinformation coming from Mulgrew over MedAV - you know, it was just a different name from Medicare and you can't ask your docs if they belong because the big beautiful plan doesn't exist yet - until he tried to shove down our throats an even more big beautiful plan which is would still be favoring if we hadn't won the RTC election.
DisclaimerThe views expressed by our individual authors are their own and may not reflect the views of the EONYC community. Just as we may not all agree with the editorial views expressed as the collective Educators of NYC community.Behind the Gates: How UMR Takes Over Utilization Management In Our Health Plan — and Why the AI & 'Clean Claim' Clauses Should Sound AlarmsWe've read the fine print. And we're right. The contract says: ”Emblem will utilize UMR systems and follow UMR protocols for the provision of UM services.” We unpack what it means for denials & claims
Meet United Medical Resources (UMR). They’re not a household name, but under the new NYCEPPO plan, UMR will become the central authority deciding what care you can and cannot get. Acting as the Third Party Administrator for UnitedHealthcare and Emblem, UMR will be the interface every member has to go through for nearly all preauthorizations, claims, and medical approvals. It’s important to know:
In other words, they’ll be the gatekeepers. And, you and your family will know them very soon if, and when we are switched over. The Bait and SwitchThe UFT’s FAQ and paid political operatives tried to downplay United Healthcare’s notorious track record with its 1 out of 3 denials of claims. The Wire warned about this ‘bait and switch’ tactic last week:
The Wire accurately foretold:
We Were Right. It’s In The Redacted Contract.Now that the UFT and MLC have voted to approve the NYCEPPO self-funded healthcare plan administered by UnitedHealthcare and Emblem, that will affect more than 750,000 active employees, pre-Medicare retirees, and their dependents, the City has finally released the redacted administrative services contract. When the draft contract first appeared, it looked like routine legalese — pages of clauses on claims, appeals, and provider networks. But we’re doing the work to analyze it. Hidden in the details is a major shift: United Medical Resources (UMR) will take over nearly all control of utilization management, moving from a shared role to one of near-total authority. On top of that, the contract allows the use of artificial intelligence to decide claims, with almost no protections in place. It also sets up a major roadblock with its “clean claim” clause. Educators of NYC‘s The Wire was among the first to uncover these risks in the plan. Our articles laid out how the deal hands UHC/UMR sweeping power over prior authorizations and warned of the dangers of AI-driven denials without proper oversight. All those who said we need to read the fine print BEFORE approving this deal: Yes, you were right, too! The devil is in these details. What the contract actually says: UMR as the master of Utilization ManagementThe contract is clear as day: UMR takes over as the primary authority for utilization management. Across multiple sections, the language makes clear that Emblem’s role is secondary, limited, or entirely absent. Here are the critical references that can be found in its Exhibit A, Schedule of Medical Benefits Schedule section:
Taken together, these provisions leave little doubt: UnitedHealthcare’s UMR is not just some subcontractor. It is written into the plan as the central and controlling authority for utilization management, claims determinations, and appeals. It’s the ultimate gatekeeper. The AI clause: minimal guardrails, maximum dangerBeyond the centralized regulatory regime, the contract carves out explicit permission for algorithmic or AI-based decisioning in claims, with weak constraints:
Yes, sometimes it’s not about what is said but what is omitted. That’s the only direct mention of AI. Absent are provisions that:
In effect, the contract legalizes a “black box” approach: UMR (or its agents) could use machine decisioning to deny claims, and the burden falls on patients/providers to challenge with limited visibility. This is precisely what our “AI Denials in the Newly Proposed Plan” Substack article warned: “there is effectively no requirement for human review unless otherwise carved out … the plan embraces AI decisioning with only vague legal compliance safeguards, which is insufficient to protect members.” Why this matters — what’s at stakeThis isn’t just about tedious paperwork. These provisions directly affect how quickly and fairly people can get care, even for life and death situations. We should expect:
What we need to fight for, nowIf this contract is going to move forward and finalized, members and delegates must demand protections that put people first:
The Contract’s “Clean Claim” RoadblockIn the contract, UMR makes clear in several places that only “clean claims”— claims submitted without any errors, missing fields, or coding issues — are eligible for payment. As the language states: “ …Only Clean Claims will be considered for payment.” On paper, this sounds like simple efficiency. In reality, it gives UMR a powerful tool: if a claim isn’t perfectly formatted, they can delay, pend, or deny it until the provider resubmits. That shifts the burden back to doctors and hospitals, creating red tape and delays for patients waiting on care or reimbursement. The concern is that this strict standard becomes a built-in loophole. Even minor errors — a wrong code, a missing authorization, or a typo — can block timely payment. Combined with the contract’s allowance for AI-driven claim reviews, the definition of “clean” could be applied more aggressively, with algorithms automatically rejecting claims before a human ever looks at them. In practice, UMR’s focus on “clean claims” is less about efficiency and more about cost control and leverage. It gives the administrator an easy way to slow down spending while putting extra strain on providers and members, who are left navigating denials and resubmissions. The Bottom LineThis contract hands UMR the keys to our healthcare system — not just to process claims, but to decide who gets care and who doesn’t. The AI clause, vague and weak as it is, could let algorithms quietly control life-changing decisions. The “clean claims” clause is designed to throw a monkey wrench into the claims process. In the NYCPPOE contract, UMR would become a primary authority for NYC employee and retiree health plan claims and preauthorizations. That places UnitedHealthcare’s administrative arm in control of what care gets approved or denied. And we know that everything behind the UHC machine is about denying and delaying to contain costs and drive their profits. We must continue to organize. Now. The question is whether union members and taxpayers will act on this knowledge before it’s too late. Read the NYCEPPO redacted contract Exhibit A: Schedule of Medical Benefits
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1 comment:
You know what's sad? Under the guise of being the progressive left, many of these people are driven by right wing instincts.
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