The newly proposed NYCEPPO healthcare plan is being sold to active
UFT members and pre-Medicare retirees as a way to improve benefits and
save money at the same time. Union leadership and the city’s negotiating
committee are distributing FAQs to calm legitimate concerns about the
role UnitedHealthcare (UHC) will have in this plan given its
well-documented record of claim denials.
The UFT’s FAQ in particular craftily tells members not to worry:
“EmblemHealth will do all prior authorizations in the Downstate 13 counties in New York State, which represents 90% of claims.”
“UnitedHealthcare,
which will process the remaining 10% of claims, will follow the exact
same standards that EmblemHealth adheres to, ensuring that prior
authorizations are handled uniformly nationwide.”
This
framing makes it sound like most members are protected from UHC—and only
a small fraction of claims (10%) will ever touch them.
But this is deeply misleading.
This is strange, even
morbid, “double speak” because another selling point from the UFT
leadership’s paid operatives is that retirees living out of state will
have more options for doctors and providers. Yet, they seem to think
UHC’s 32% denial rate is somehow not going to be a big deal for most of
us since it’s only going to be experienced by the 10%, mostly retirees,
who don’t live locally.
Some active members
and other city workers also live and work outside these counties—they
too will fall under UHC administration.
According
to the lead consultant pushing this plan, even inside the Downstate 13,
the standards remain UHC’s standards. Emblem may process the paperwork,
but the rules—the criteria, or standards, that decide whether your care
is approved or denied—are UHC’s.
This means the entire system, for every member, retiree, and family, is governed by UHC’s standards.
That’s the Trojan horse in this plan.
Buried
within this proposal is a devastating emerging reality: if
UnitedHealthcare (UHC) standards for care, prior authorizations, and
denials are applied across the board, every member—active or retired,
teacher or paraprofessional, therapist or counselor—will be subject to
one of the most notorious denial machines in the insurance industry.
Is this speculation? No!
It’s written plainly in the leaked transcript from September 10th MLC healthcare presentation meeting. There we read and hear testimony and a Q&A between MLC leaders, the paid “independent” lead healthcare consultant from Segal, Chris Calvert, and other union leaders.
In
this meeting, the lead consultant informs those gathered that even in
regions where EmblemHealth is technically the administrator, the
standards being enforced will be UHC’s standards.
In other words: every city worker and retiree will live under UnitedHealthcare’s rules, no matter where they live.
Here is one of the exchanges where Calvert admits to the UHC standard being applied to all:
Here’s what’s being said:
Alan Klinger, the MLC and UFT lawyer, who also is the MLC’s appointee to the joint tripartite committee with the City,
interrupts Calvert seeking to clarify that in the downstate 13 region,
prior authorizations (the approvals you need before certain care or
procedures are covered) will go through Emblem. He goes on to say, that
if a union local’s administrators have concerns, they go through Emblem,
which manages this process locally.
Chris Calvert
responds by emphasizing that the standards being applied will be
UnitedHealthcare’s standards—so no matter where a member lives, the
rules are the same. But for downstate 13 specifically, the actual
reviews and management of those prior authorizations will be carried out
by Emblem, not directly by UnitedHealthcare.
In short:
UnitedHealthcare
is not a neutral player or some benevolent caretaker. It is the largest
corporate health insurer in the United States and has a documented,
checkered history of putting profits above people. It leads private insurers with a 32% denial rate. According to an American Medical Association survey, doctors
have ranked UHC as the insurer with the most prior authorization
hassles, with 72% of physicians giving UHC a “high” or “extremely high”
burden rating.
The same MLC meeting revealed that AI is very much part of this new agreement.
Ongoing Litigation:
Class actions accuse UHC of violating federal law by systemically
denying medically necessary care. Testimony from insiders revealed
denial quotas built into policy. It also is under multiple
investigations for fraud and overbilling.
A Pattern of Abuse: Reports nationwide show seniors denied cancer drugs, patients forced out of hospitals too soon, and families buried in appeals.
Multiple Federal Investigations:
UnitedHealth Group is currently facing both civil and criminal
investigations by the U.S. Department of Justice (DOJ) for fraud and
overbilling.
UnitedHealthCare is not who we want controlling our care, nor setting the criteria.
If delegates approve this plan:
Doctors and patients lose authority. UHC’s criteria, not medical judgment, will determine treatment.
Retirees
are exposed. Thousands living outside Downstate 13 will deal directly
with UHC—and face its merciless denial machine without a buffer.
Everyone
potentially faces the same denials. Inside Downstate 13, Emblem is only
administering UHC’s rules. Members will still suffer the same
rejections and delays.
Vulnerable populations are
targeted. Retirees, post-surgical patients, lowest paid city workers and
children with special needs will be most harmed by premature cut-offs
and denials.
Members drown in bureaucracy and red tape.
Appeals, phone calls, and paperwork, stress will replace care. Those
without stamina or know-how will simply go without.
This isn’t abstract. Imagine:
A
retired teacher recovering from hip replacement is cut off from rehab
after just a week, even though her doctor prescribes three. She either
pays thousands out of pocket or risks lifelong mobility issues.
A child of a UFT paraprofessional loses access to speech therapy because UHC’s standard says “progress plateaued.”
A
city worker battling cancer is forced to switch procedures
mid-treatment because UHC refuses to cover the one that her doctor
believes will work for her.
These are not
“hypotheticals.” They are documented cases from UHC’s history. And they
could be our reality if this plan is approved.
Equally troubling is how this plan is being sold.
Leadership knows UHC’s record.
They know thousands of retirees live outside Downstate 13.
They know even within Downstate 13, UHC’s standards will rule.
And
yet, instead of being upfront, they’ve chosen to spin, minimize, and
mislead. That erodes trust. And it betrays the union’s responsibility to
protect its members’ and their families’ health.
Delegates
are not voting on a simple healthcare plan change. They are voting on
whether to hand the criteria of members’ care to UnitedHealthcare.
It’s one of the most consequential votes they will cast.
They
are voting on whether retirees and families must fight an insurance
giant for every day of rehab, every specialist visit, every procedure,
every medication.
They are voting on whether to let leadership’s spin override the lived reality of denials, lawsuits, and suffering.
This is not about numbers on a spreadsheet or “cost savings”. It is about people’s lives.
It cannot be overstated: being under UHC’s standards is, indeed, A MAJOR CHANGE.
We did not have their standards dictating our city premium-free plan for the last several decades. This is not
keeping things virtually “unchanged” while making improvements and
saving money as the paid operatives for Michael Mulgrew’s Unity
leadership caucus tell us.
Rejecting this plan does not mean rejecting cost savings or efficiency. It means demanding a plan that:
Keeps doctors and patients—not insurers or city bureaucrats —at the center of decision-making.
Provides transparency and honest communication with members.
Protects retirees, especially those outside Downstate 13.
Respects the union’s duty to safeguard both wages and health benefits.
The
NYCEPPO plan is being presented as a step forward. But it is, in fact, a
step backward—a Trojan horse that hands our care to UnitedHealthcare.
UnitedHealthcare sets the standards for everyone.
Retirees and active members outside Downstate 13 are fully exposed.
Inside Downstate 13, Emblem, the local regional administrator, simply enforces UHC’s rules for care.
The FAQ spin is a distraction, not a protection.
Delegates must see through the misleading promises and protect the membership.
For
the teachers recovering from surgery. For the retirees fighting cancer.
For the families raising children with special needs. For every member
who depends on the union to safeguard their health.
