Inside UnitedHealth Group and Optum

We're gonna create an environment where you, yeah, you may pay only $12,000 or $15,000 over the span of a year, but we're gonna get you healthy. We're gonna get rid of your chronic disease. We're gonna get it so that you don't become a diagnosis chart-making, money-making machine, green out of healthcare in the last 10 years of your life.

You didn't build your clinic to feel like an employee in your own business. I'm Matthew Gologli, and on Out of the System hosted by Dr. Talks, we challenge the broken rules holding healthcare entrepreneurs back. Hear from clinic owners, Rivals and builders who are creating bold, profitable patient-centered practices and doing it their way.

So welcome to Saturday Morning Coffee with Matt. And this is a new thing that we're giving a try. A couple, 2 Saturdays every month, I'm gonna be coming to you live to discuss major topics that are impacting healthcare, not only here in the United States, but eventually we'll dive into some of the issues that are similar going on around the world as well. I'm coming to you live from Chicago, Illinois. where I am attending the CE Lasers User Conference, where we are one of the co-sponsors and sharing with a bunch of doctors and chiropractors and all kinds of great and wonderful people in the room about how to grow the practice. But something struck me last night when we were at the welcoming cocktail reception, and that is the ongoing pain and the challenges that doctors are facing. Day in and day out for them to be able to make their ends, to make ends meet. In this room, there's lots of physical therapists, there's lots of chiropractors, and we see and we hear this constantly about, I don't know how much longer I'm going to be able to hang on. And so today what I want to do is I want to talk to you about the monopoly that has become UnitedHealthcare. Now, before I dive into this, I have to give you some perspective on how actually just how big UnitedHealthcare is and its impact on healthcare in the United States. To say that UnitedHealthcare is the 10,000-pound gorilla in the room is a bit of an understatement. To put it into perspective, this last year, UnitedHealthcare generated over $449 billion. That's with a B, billion dollars in revenue. To put that into perspective, only 2 companies generated more revenue in the United States in their business than UnitedHealthcare. Those are Amazon and Walmart. They're ahead of Apple. This is how big UnitedHealthcare is. Now, this is not going to be a bitch session about UnitedHealthcare. In fact, this is actually going to be a very much of an education system about what UnitedHealthcare has done in order for them to be able to have such a massive chunk in control of the market. You see, when you're in medical school, what you did, you might've had cadavers that you worked on. You studied the human body and you would have ways to be able to actually practice on the body, right? You would have cadavers and then eventually you'd go to humans and all that. Well, see, in the world of business, in going to business school, we do a thing called case studies. And case studies are how we learn about how businesses make their decisions and how they wind up to where they are. Now, one of the key things that you do in the world of business is that you want to be able to understand, you want to be able to control your market. You want to be able to, your competitors, right? You have competitors and business is the competitive game. And so most business owners and people that run businesses are pretty competitive people, and it's our way of keeping score, if you will. Okay. And so What I want to share with you today is this isn't going to be just about, oh, let's talk about how evil UnitedHealthcare is. This is actually a lesson for you about how you can structure your business, but yet do it for good. Okay? Now, if you're currently working in the system, then this is going to be a roadmap for you on how you can build, you leave the system and create Freedom and agency over your own life. So let's just paint the picture here. Okay? So let's paint this picture for what UnitedHealthcare has done. Okay? So let's start with a patient. Now, I'm going to paint this as a picture of a single patient, but this is not one person. So this is not a specific person, but what this is, is this person is a pattern. And what you may recognize in the end of all of this is you may recognize yourself in this person. You may recognize a loved one in this person, but I want you to envision a woman who's 71 years old and she is on Medicare Advantage and she has this card in her wallet that says UnitedHealthcare. Okay? So she goes to her primary doctor and the sign on the building has a local name on it. It might have You know, Dr. Schlammenberger's Primary Care. Okay. And it's been that same name for 20 years. She's been going to see this doctor for 25 or 30 years. Okay. But what the sign doesn't say is that the practice was bought by a company called Optum about 4 years ago. Now, Dr. Schlammenberger is still there. He's still seeing patients. He's 75 years old. He's been doing it for over 50 years. And he knows this woman, he knows Betty's family, he knows Betty's husband, he knows Betty's kids. I mean, his kids and her kids played baseball together. But 5 years ago, in a world where he was unable to make money, he wound up selling his practice to Optum. In exchange, started working for them for 5 years, 5 or 6 more years. Okay. Now he goes, she goes, and Betty goes to see Dr. Flammenberger and he writes her a prescription. Standard stuff. What happens though is she takes that prescription and it's filled through a pharmacy benefit, the pharmacy benefit manager, pharmacy benefit company, and it's called OptumRx. Now Optum owns the practice. Optum owns the pharmacy or the pharmacy benefit manager, and Optum is a separate company of UnitedHealthcare. So Betty is paying her, Betty is paying her premium, her Medicare Advantage premium to UnitedHealthcare. UnitedHealthcare, then she goes to see a UnitedHealthcare doctor, gets it filled at a UnitedHealthcare pharmacy. Okay? Now it continues on past that. The nurse will come to her house, say, for a wellness visit. Okay? Friendly nurse is great. Takes about an hour. That visit comes through a program run by, guess what? Her insurance company. The diagnosis the nurse writes down and how much Medicare pays that insurance company is all controlled. Okay? Then let's say Betty falls and breaks her hip. Surgery goes well and she goes to rehab. Guess what? Surgery center owned by Optum. The rehab center owned by Optum. Her doctor says she needs 3 weeks, and on day 12, she gets a letter saying her coverage for rehab has ended. That decision was made by her insurance company. She goes home and the health— home health agency sends someone out. That agency was bought last year. Guess what? It was bought by Change Healthcare, which is owned by UnitedHealthcare. So every— or I'm sorry, not Change Healthcare doesn't own the home healthcare, but the home healthcare agency is bought by UnitedHealthcare. Now, every one of those claims, there has to be a company that processes every piece of data. And the company that processes all that data is Change Healthcare. So the insurance company, the doctor's practice, the pharmacy company, the home visit, the home healthcare agency, and the claims processor all roll up to the same parent company, and that is UnitedHealthcare. Now, if you were to do this as a physician, let's say you as the physician were to be on your own and you as the physician were to own a piece of the surgery center and to own a piece of the home healthcare company and to own a piece of the rehab company, and you were processing that claim because it's going through Medicare, that would be in violation of the Stark Law because you are an individual doctor. So there's a Stark Law that is put in place that the individual doctor cannot financially benefit from the referral. So if I am the doctor and I referred you to do surgery and I owned that surgery center, that's what we call self-dealing, and that's against the law. But if a corporation does it, it's not against the law. Okay. So what happens a lot of times is that doctors wind up getting scared about all these things, and we'll talk about that in just a little bit. Okay? So all of this is generated by the same parent company, and that's United Healthcare Group. So the company collected her premium, the company paid itself to treat her, and the company decided when the treatment stopped. That same company, United Healthcare, took in $447 billion last year. Now, if you cannot picture that number, You can't wrap your head around what that number looks like. Let me put it into a way that you can understand this. I want you to take a golf ball. Now, everybody pretty much knows the size of a golf ball. It's about like that. Okay? And I want you to think of that every golf ball represents a dollar. Now, if you were to cover a football field from end zone to end zone, from sideline to sideline, With golf balls, one layer, that's about $3 million. Okay. To lay out what UnitedHealthcare took in last year in revenue, you would need 152,000 football fields covered end zone to end zone, sideline to sideline with golf balls. That's a carpet of golf balls bigger than all of New York City. And what they kept as profit, this is last year alone in 2025, they kept $12 billion in profit. That is 4,100 football fields. Now here's the thing that should really start to scare you. A couple of things. One, through at the time of this recording, October 3rd, 2026, UnitedHealthcare has already reported Through 6 months of 2026, $12 billion in profit. It is estimated their profit will clip over $20 billion. Okay? By the way, they keep paying you less. Okay? Now, they kept $12 billion in profits so far for 2026. That's 41 football fields. Now, here's the amazing thing. They spend what they view as to the common man, common woman, a tremendous amount of money on lobbying our congressmen and women and our senators. Okay. So here's, here's something that's really scary is they spent, and just in what they spend on what would be lobbying and campaigning in the last 2 years is 6 fields of golf balls. So what they do is they spend 6 football fields covered with golf balls in order to protect a carpet, the revenue that is the size of New York City. That's how cheaply you can buy Congress. They spent $17 million last year, $17 million. Last year to protect $449 billion revenue. Now, so this is the challenge. UnitedHealthcare is literally multiple companies under one roof. Most people think it's an insurance company, and the average American thinks that you as the doctor Are the problem. What they don't understand is they don't understand that UnitedHealthcare controls the whole thing. Okay? So let me put this into greater perspective for you so you can really truly understand this. So UnitedHealthcare has a company that generates the premiums. Now, by law, they are required to pay out 85 cents of every dollar that they generate In healthcare premiums, they are required by law to pay those out. Okay? Now, last year they paid out 92 cents of every dollar that they collected in premiums. This year they're touting it that they're below 85% or 85 cents. Now, why in the world is this important to understand? And why is it important to understand that UnitedHealthcare owns the doctor? And owns every channel. Well, here's, here, let me just, just follow me in this. On the insurance side, there's about 50 million Americans who carry a card that says UnitedHealthcare. Okay. Now UnitedHealthcare is one part of it. The health insurance company is actually the least profitable part of the entire machine that is known as UnitedHealthcare. And by the way, this is the same for Aetna, CVS, Caremark. This is the same for all of them. Okay? But we're going to just keep painting this picture with UnitedHealthcare. They have this other company, it's Optum. Optum is everything else. Optum is the doctors. There's nearly 90,000 physicians that are employed or affiliated with Optum. This makes Optum the largest employer of doctors in the United States. This is bigger than any hospital system. Optum is the pharmacy company. OptumRx is one of 3 companies that together control about 80% of the prescription benefit market in this country. What was created in the 1970s to be a safeguard and an advocate for the patients has now been bought by the major health insurance companies and now is a profit money-making machine at the expense Of the patient. So you can get, and here's what makes this so hard to see. They don't put their name on the door when they buy a medical practice. They remain the same. The sign remains the same, same name, same building, same doctor. The only thing that changes is who that doctor works for. So you can go from the insurance card to the doctor, to the pharmacy, to the surgery center, to the nurse in your living room, and never leave the company and never know it. Okay? So this is how they get around this profit cap that was created by the Affordable Care Act, which everybody touted, oh, that we're going to make sure the insurance companies aren't greedy and make all this money. But the reality is, is the money never left the building. It went from one division of the company to another division of the same company. And the division that received it, Optum, has absolutely no cap on the amount of profit it can make. None. Optum can keep whatever it makes. So the law caps what the insurance company can make. It does not cap what the insurance— oh, the insurers own clinics and pharmacies can keep. Now, here's where it gets really sleazy. You literally can look at the numbers within UnitedHealthcare and you literally can see what is going on. Okay? Last year on the insurance side, UnitedHealthcare made $9.4 billion in operating profit. Optum made $9.5. Okay? And remember, so there's money that's moving. There's $168 billion that moves from the left pocket to the right pocket. Okay? The biggest customer by a mile for Optum, 62 cents out of every dollar that Optum took in came from, guess what? UnitedHealthcare. Okay? All right. Now, because of that, What do you think happens? Do you think UnitedHealthcare denies claims on the same rate that they do for you who are not part of their system? So if you, if you were in this situation, if you own both sides, if you own the health insurance company and you own the practices and you own both sides of the transaction and one side had no cap on its profit, what would you do? You would pay that side more money. And you don't have to guess that that's happening. It is because researchers at Brown University looked at this and they published, and what was published in, I think it's called Health Affairs, which is one of the most respected journals in health policy. I haven't read it myself, but this is what my research tells me. And they use the pricing data that insurers are now required to make public. They compared what UnitedHealthcare pays its own Optum practices To what it pays independent practices for the same services in the same areas. You ready for this? On average, UnitedHealthcare pays its own practices 17% more. Let that sink in for a second. 17% more is paid to practices that are owned by UnitedHealthcare. And the markets where UnitedHealthcare is the dominant insurer and provider, the gap went as high as 61%. Now, remember when I started this and I told you in business school, what we do is we do case studies. Now, one of the fascinating things about case studies is that you always get to watch how a company is trying to corner the market. Because when you can corner the market, you actually can then set the price. This is the whole concept of a monopoly. Now, monopolies are kind of hard to prove these days because there's so many different facets and ways that they exist. They're not just a straight-line monopoly like Standard Oil had back in the early 20th century. But the reality is that what you, if I were looking at this from a pure business standpoint, what I would do is I would figure out a way if I could make more money by owning all of the practices, guess what I would do? I would overpay for buying the practices because if I can control 60 to 70% of the market, it doesn't matter if I overpay. Once I do and I reach a particular level and there's some kind of algorithm and chart that they have, trust me, then I can start to pay exponentially more for care and I can make more money. I can put as many people as I can on my rolls. And for my insurance company, I really don't care if my health insurance company makes money because all the money is going to go to my pharmacies, to my practices. This is what's called complete and total monopoly control. Okay? That means that if you— what this means is if you are an independent doctor, let's say you're saying, I'm trying to be the beacon of hope for my market, and what I want to do is I'm going to stay independent. I'm not going to let them buy me and I'm going to stay independent. Well, guess what? UnitedHealthcare is not going to pay you the same it pays its own practices. In fact, UnitedHealthcare is going to most likely, and this is what I would do, I can't prove that they do this, so I have to be very careful. But if I were an insurance company, what I would do, and I had a large group that hadn't caved yet where I could buy them, I would slow pay. I would deny more. I would delay more. I would make them jump through a lot of hoops and hurdles to be able to get paid. And I would pay them less and I would put them in a place, in a vice where they would have no choice but to sell to me. And of course, the longer they wait, the lower the price is going to be. So this means that the independent doctor, same exam, same procedure, same town, practice down the street gets paid 17% less, or your practice gets paid 17% less or up to 61% less. Company setting your rates is also your competitor. Now think about what this means if you're the one paying the premium. Higher payments go to their own clinics, which means higher medical costs on paper. Higher medical costs on paper are how next year's premium gets justified. So the premiums continue to go up, which means UnitedHealthcare by law is required to pay out And the health insurance companies are required to pay out 85 cents on every dollar. And if premiums continue to go up and they control all of doctors and the practices, pharmacy benefit managers, and those pharmacy benefit managers are paid more, they continue to profit. This is the problem. So then we have our tax dollars. UnitedHealthcare is the single biggest line of business is not employer insurance. It's Medicare. They get $171 billion last year. About half of the insurance side comes from Medicare. Your tax dollars, your tax dollars are the ones that go to fund their growth. Your tax dollars. Your payments to Medicare, your insurance premiums go to continue to enrich them, which they then take to then go buy or control or influence more politicians. By the way, that's not a Republican or a Democrat thing. They contribute equally to both sides of the aisle. So this is not a Democrat thing. This isn't a Republican thing. This is an American issue. You see what we traded with the Affordable Care Act is we created our own form of a quote unquote single payer system. It's really controlled by 5 entities in the United States, the biggest being UnitedHealthcare. Our tax dollars go to fund their control of the health system in the United States. This control of the health system is not designed for preventative care. It is designed specifically For the enrichment of the shareholders and the executives and the employees of UnitedHealthcare. Okay, so here's how Medicare Advantage pays. The government gives the insurance company a monthly amount for each patient, and that amount goes up if the patient is sicker. More diagnoses on the chart, more money every single month. Do you understand why there's no value in them making sure that somebody is healthy? So remember the nurse who came to Betty's house? That's what that visit is for. Now, I'm not saying the nurse isn't kind. That's not what I'm saying. I'm not judging the nurse. Okay. And I'm not saying the visit has no value. What I am saying, telling you is that as this does on the business side, it finds diagnoses because guess what? They see that Betty is on Medicare Advantage and the more diagnoses, the more sick she is. Therefore, the more of their, of your tax dollars go to benefit UnitedHealthcare. Okay. Now, the Inspector General at Health and Human Services looked at this and they found $7.5 billion in payments across the industry for the year 2023. And they called these questionable. These were diagnoses that showed up on a home visit or a chart review and nowhere else. No follow-up appointment, no test, no treatment. UnitedHealthcare share of that $7.5 billion was $3.7 billion. It's about half. The Inspector General called those payments— these are the Inspector General's words, not mine— those payments questionable. Now, the Justice Department is reported to be investigating. I don't know the extent of that. No court has found fraud. No comp— the company says its practices are appropriate, but these are the facts that we have today. The facts are really simple. The more diagnoses, the more sick The more supplements and benefit, or the more payments they get from the United States government. So I'll open this up for questions in just a minute. Okay? And I'm going to share with you, by the way, how you can get out from underneath this. So I don't want this to boil up with doom and gloom. Okay? So this is really, this is this, and then it goes on to impact like end of care, right? Again, the more diagnoses, the more money they get paid, the longer they can keep that patient alive, et cetera, et cetera, the more money. Your patient, the body becomes basically a money machine towards the end of how much we can extract. Okay? So remember, your doctor works for your insurer, which means that each and every single year as they buy, there's fewer and fewer choices. So what are we doing? What do we do about this? From the patient's standpoint, you can ask who owns, but quite frankly, that's getting to be harder and harder to delineate. And I really don't think that that really helps. Okay. And really a lot of this, by the way, falls on the patient, right? They have to then fight for coverage. They have to do all of these things. You can Google UnitedHealthcare sucks, go on TikTok. I mean, there's literally channels dedicated to this. Buyer beware. It's a bit of a rabbit hole to go down. Now, But let's talk about you as the physician and the practice owner, or for those of you that are part of the system. So I want to be really clear. We don't just work with people that are out of the system. We actually help people leave the system. This afternoon, I will speak to a room of 90 doctors, and I will tell you that about 50% of them are in the system looking to get out because they know that there's something better. They will be like Dr. Janet Ng, who is down in that room, and she was an ER nurse for 30 years and realized that Nobody was getting any better. Or Frank Shallenberger, who we just had on our podcast about a week and a half ago, tell his story 50 years ago of when he decided to leave emergency medicine. But here's the thing. If you are the physician and you own the practice, you can look at your rates and you can realize that your insurers are required to publish what they pay. But they, you can find out now what your biggest payer pays the practice down the street that it owns. You may not like what you find, but you should know. Second, take a look at how much of your money comes from your insurance company. Now, we tell doctors to do this all the time. If you were to take all of your payers and you were to say which ones pay the best and which ones pay the least, and you were to do, let's say you have 10 of them and you were to get rid of the bottom 20% of those that don't treat you well, that don't pay you well, that pay you slow, you actually are able to free up time for you to start seeing cash-based patients. Now, This always comes back to them to the issue of will your patients pay cash? It's really about a reframe of how you see things because of the very simple fact most Americans, the average American family will pay $18,500 this year out of pocket, excuse me, out of pocket after insurance premiums for care. Now that $18,500 is going somewhere. It's going to an MRI that was not needed. It's going to a whatever. It's going to, you know, whatever thing is not more pills and things aren't necessarily going to make them healthy. Your job as the physician, as the provider, is to say very simply, we're going to create an environment where you, yeah, you may pay only $12,000 or $15,000 over the span of a year, but we're going to get you healthy. We're going to get rid of your chronic disease. We're going to get it so that You don't become a diagnosis chart-making, money-making machine green out of healthcare in the last 10 years of your life. Build— the bottom line is learn how to build services that don't run through insurance at all. Not just one, but multiple. Something your patients want, something that you want to provide, something that you want to become good or great at, that they pay you directly. Now, I'm not just talking about concierge care. Okay? That's not exactly what I'm talking about. I'm talking about the things like anti-aging and longevity or regenerative therapies or our, from our chiropractors, it's using a tool like CE Lasers to help with things like neuropathy. I was just sitting at breakfast this morning and the doctors and I were all sitting around talking about how using a machine like the M7 that CE Lasers makes and how they're using it to treat neuropathy. It's the only thing out there that we know of that we've been able to find that is actually helping patients with neuropathy because the pills that they give them make them addicted. And by the way, being addicted to the pills, to the opioids, being addicted to high blood pressure medications, those become annuities. Companies like UnitedHealthcare. And the more of those you're on, if you're on Medicare Advantage, The more your tax dollars go to pay and profit companies like Optum and UnitedHealthcare. So I'm going to open this up for questions, but I want you to understand something. Here's the final thing that I want you to take. This shouldn't be doom and gloom for you. You see, education is not just power. Education is one component of the power. It's the application If education is knowledge and wisdom, the application of that knowledge and wisdom is where power comes in. At Mavericks, we know and we believe that you deserve to be the healer that you always wanted to be. We believe that there is a better future for healthcare, not only here in America, but in Canada, in England, in Australia, and throughout the globe. One where doctors and patients make decisions on their care that is in the best interest of the patient and their wallet and their long-term health, not on the dividends and the bonuses of the executives at the health insurance company, and not to the benefit of a politician's PACs. Now, this is not an answer that's going to come from Washington, D.C. This is not an answer that's going to be— reform of the healthcare system is not going to happen in that way where we go to the politicians or we demand that UnitedHealthcare and Blue Cross Blue Shield and Aetna and Optum and CVS all change their ways. In fact, the last time we did that, we handed them the golden goose that has made them wildly profitable in 2010 when we passed the Affordable Care Act. I believe Our doctors believe that are in our system, our doctors that we work with day in and day out, our staff, we believe that we have the best answer available for society today. And that is for you to know how to become independent. You see, when you no longer have to take Medicare, the Stark Laws of self-dealing no longer apply to you. When you have cash-based services, you can now run your practice the way that you see fit, and then you can decide if you want to own the patient journey. Now, I'm not going to suggest that you start to go out and buy pharmacies or pharmacy benefit managers, but you certainly can set up structures that are in the best interest of the patient where you can provide the right types of services. We have doctors that now have their own physical therapy units. Inside the practices and do this for Regen. And those physical therapy centers no longer take insurance. You see, we can provide better care, better preventative care for the patient by opting out of the system. Better patient care provides an environment where we have a better, healthy United America and a better, healthy world. These people no longer become a financial burden in their last 10 years. And become productive members of society. And we can fix the system by moving outside of it. So just remember, the people that built the system, they're spending 6 football fields every year to make sure that it stays that way. We can show you how to take back control of your care, of your life, of your practice. We can fix it one practice One patient at a time. Doctors taking the patient journey back and running it the way it should have been run all along. And that's what we call the Maverick Model. So I will take, if anybody is on and wants to put a question into the chat, feel free to go ahead and type that into the chat and tell your friends about this. We will begin live streaming these on other social media platforms. here, I believe, in the next 2 weeks. This is the second round of these, of Saturday Morning Coffee with Matt. But this is something we're going to be doing every other Saturday, twice a month. We'll get a schedule out for you. We're going to be diving into topics like this so that you, the physician, can be better educated. Again, education is in power. Education, knowledge, and wisdom, and then the application of that. Is where the power is. All right, see if we have any questions that have come in. We do not. All right, so that's what we have for Saturday Morning Coffee with Matt, coming to you live from Chicago, Illinois, getting ready to speak later this afternoon at CE Lasers. Next time you see us, we'll be back here in Chicago at the ANNA conference, speaking to about 45 doctors where they're learning how to do ultrasound. to help them escape the industry so they can go out and do regenerative therapies outside of the insurance-based world. And we'll be at A4M in December. So there you go. Take care, everybody. Have a wonderful day. Take care.

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