Are you comfortable if United Healthcare (UHC) Standards Are Applied To All Claims and Care?
If so, should delegates delay this vote or vote 'no'? You decide.
A Trojan Horse in Our Healthcare?
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.
Thousands of retirees and their families live outside the Downstate 13. For them, UnitedHealthcare will be their direct administrator and gatekeeper—not Emblem.
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 potential 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:
Standards = UnitedHealthcare rules (applied to everyone).
Administration in downstate 13 = handled by Emblem (the local entity).
What This Could Mean for Members and Retirees
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.
How do we begin taking steps to end this nightmare?????
NO ! Absolutely not ! So effing outrageous ! No other industrialized country healthcare being a business