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Hey. There it's Chris Bentley, host of Here

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0:47

You. Have had these counter protesters who

0:49

increasingly been confronting them and we

0:51

saw what have late last night.

0:53

Early this morning, violence by counter.

0:55

Protesters and police at some

0:58

college campuses while others are

1:00

seeing progress on talks between

1:02

administrators. Demonstrators: In

1:13

Wednesday the first of May and this is

1:15

here and now any time from Npr in

1:17

Wb you are Boston. I'm Chris Bentley. Today.

1:21

And the show will speak to

1:24

the new Ceo of The Onion

1:26

about the future of America's finest

1:28

news source. Also, a doctor turned

1:30

whistleblower says a major health insurer

1:32

pressured her to deny claims before

1:35

she had a chance to properly

1:37

review them. The answer is hiring

1:39

more doctors, not forcing doctors to

1:41

make quick decisions that might disadvantaged

1:43

the patients who are desperately seeking

1:45

this care. But first

1:48

Police. Continue to respond to college

1:50

campuses around the country where student protesters

1:52

have been calling for a ceasefire in

1:54

Gaza and divestment from Israel. Were going

1:57

to continue checking in around the country

1:59

today. Robin Young and Deepa Fernandez

2:01

spoke to people on campuses from coast to

2:03

coast this morning, and we're going to bring

2:05

you a few of those conversations. Follow

2:08

npr.org for the latest as news

2:10

develops. But we'll start

2:12

in Los Angeles, where things turned

2:14

violent, after people in masks showed

2:16

up to disrupt a protest encampment

2:19

at UCLA. Leave the campus, stop

2:21

the police! Leave

2:23

the police and support everything else from here! Let

2:26

the ghost study stop interrogating

2:28

church! Reporter Steve Futterman was on

2:31

the scene last night and spoke to Deepa

2:33

from the campus earlier today. So

2:35

UCLA Chancellor Jean Block called the

2:38

camp unlawful, but it was peaceful.

2:41

Then counterprotesters showed up, and it's reported

2:43

they came with clubs and tried to

2:46

tear down the barricades surrounding the encampment.

2:48

What do we know about what happened

2:50

and who initiated it? Well, this

2:52

has been escalating throughout the week. I've

2:54

been here since last Thursday off and

2:56

on when the encampment was first put

2:58

up. And what you've had

3:01

in the last few days are

3:03

these counterprotesters coming and

3:06

challenging the people inside the

3:08

encampment. Last night it just increased

3:10

to a much higher level. They

3:12

came not just with the megaphones, they started

3:14

to take down the barricades. And the barricades

3:16

were what was separating the

3:18

encampment from anyone else. And that's

3:21

when these fights broke out. There were

3:23

fist fights, I saw people with sticks. There may

3:25

have been some type of pepper spray used. We

3:27

don't know who may have used it. It was

3:29

some type of irritant. I had a bit in

3:32

my eyes. Nothing serious. It

3:34

wasn't tear gas. But that's what really resulted. We

3:37

saw one professor tell the LA Times

3:39

she described the group as a rampaging

3:41

mob that attacked the peaceful encampment. Others

3:44

have said campus security watched

3:46

on but didn't initially get involved. What

3:48

do we know about that? Well,

3:50

that does seem to be the case. They've

3:52

not had actual UC police at the

3:55

scene 24 hours. They've been here

3:57

at various times. But they've had what you would

3:59

call like... private security people who are

4:01

not law enforcement people trying to

4:04

separate anyone who might come up to

4:06

the encampment and last night when

4:09

the when this got a bit testy

4:11

more than test it became violent the

4:14

security people more or less pulled

4:16

out and then you had some you see people

4:18

here the fight sort of went on without

4:20

when i got here the round one thirty there

4:22

was really no one interfering trying

4:25

to stop the the fight taking place

4:27

they sort of let them go on

4:29

and simmer finally there

4:31

was law enforcement here the other pd

4:34

california highway control they finally moved in

4:36

and basically they pushed people out of

4:39

this adjacent area to the

4:41

encampment and state we've heard

4:43

from some of that pro-palestinian protesters

4:46

who are in the encampment that they

4:48

had to defend themselves and they feel

4:50

like the university talks about the security

4:53

of students that they weren't protected has

4:56

the university spoken out at all they've

4:58

not really said much they've been very very

5:00

quiet throughout the week last night we heard

5:02

that they declared the encampment basically

5:04

illegal uh... we're wondering now

5:06

whether there's going to be another move

5:08

by the ucla administrators to try to

5:10

tear down the encampment maybe like we

5:13

saw at columbia but no indication of

5:15

that right now yet it's been it's

5:17

been a very touchy situation for them they

5:19

are inside their encampment as far as

5:21

they appear right now and they would

5:23

be very happy just to be there

5:25

and do what they do make their points

5:27

known that you have had these

5:30

counter protesters who've increasingly been

5:32

confronting them and we saw what happened late

5:34

last night earlier this morning report

5:36

a few foot a minute ucla thank you well

5:40

at brown university in rhode island a rare

5:42

moment of accord pro-palestinian protesters at

5:44

brown had been demanding that the university

5:46

divest from any companies with ties to

5:48

his real and they're

5:50

not going to be able to pay a

5:53

student leader announced an agreement came after the

5:55

school promised a vote on the divestment or representative from

5:57

the brown dot that's going to have signed an agreement

6:00

and we have gotten a vote from

6:02

the full corporation during their October

6:04

corporation meeting. The

6:06

corporation is the highest governing body at

6:09

Brown. In exchange, protesters agreed to dismantle

6:11

their encampment. Owen Dahlkamp, a section editor

6:13

with the student newspaper The Brown Daily

6:15

Herald, is here. And Owen, just tell

6:17

us what it's like there on the

6:20

campus today. Did they clear out by

6:22

5 p.m. yesterday as they were asked

6:24

to? Yeah, thanks for

6:26

having me. Yes, they did clear

6:28

out by 5 p.m. yesterday. The

6:31

campus's main green, where the encampment

6:33

was originally hosted, is completely

6:35

clear today and back to regular student

6:37

activities. There are a few remaining fresh

6:40

grass spots where tents were set up throughout

6:42

the week, but other than that, there's no

6:44

mark. And what is the century

6:46

getting from students? Do they feel optimistic

6:48

about this? Or, you know, we're thinking

6:50

a vote on divestment is not divestment.

6:53

Do they think maybe it's a stalling tactic?

6:55

Or is this being looked at, something

6:58

other schools can see, a smart

7:01

move for both sides, the school

7:03

and the protesters, to find a

7:05

way out? Yeah, a

7:07

lot of the student activists, especially the lead

7:09

organizers that I've been talking to, are optimistic

7:11

about their chances of a divestment proposal

7:14

going through at the corporation. They have

7:16

talked to several corporation members who they

7:18

say are receptive to divestment proposals, if

7:20

not outright supportive of these divestment proposals.

7:22

But as of now, it's unclear whether

7:24

or not this will go through. But

7:26

if one thing's for certain is that

7:28

it caused a peaceful resolution to this

7:30

encampment, which is something we really haven't

7:32

been seeing at other colleges around the

7:34

U.S. Well, let's hear a little bit of

7:37

the sound you captured on Monday when these

7:39

things were being negotiated and people were demonstrating.

7:41

So there's the claim, the

7:43

sort of demand, and

7:53

now some students we understand are going to be

7:55

able to negotiate with members of the board

7:57

to have ongoing conversations. But meanwhile, Do

8:00

you get a sense of how popular

8:03

these protests were? Did Jewish students feel

8:05

threatened as they have on some campuses,

8:07

or were there counter-demonstrators? Yeah,

8:09

there was very minimal counter-demonstrators or counter-demonstrations

8:12

on campus, and they were mostly from

8:14

community members in the broader Providence and

8:16

Rhode Island community. I

8:19

wrote a piece for the Brown Daily Herald on

8:21

the second day where I interviewed prominent Jewish student

8:23

leaders from around Brown

8:25

University's campus, and some of them expressed

8:28

dismay with the encampment while

8:30

some were actively part of the encampment.

8:32

So I don't think there was one

8:34

unified Jewish student voice view. It wasn't

8:36

monolithic, but there was a diversity of

8:38

viewpoints as to this campus. I

8:41

will say that our university president, Christina

8:43

Paxson, sent out an email the day

8:46

after the night the encampment started saying

8:48

that she had received no reports of

8:50

any sort of anti-Semitic threats, but

8:53

there are reporting avenues that students can take if

8:55

they do feel that they are being harassed. Well,

8:57

I have about a minute here. Oh, and I'm wondering,

9:01

we understand your paper is writing, the

9:03

charges against 41 students who

9:05

were arrested back in a sit-in in December,

9:08

those charges won't be dropped. What about

9:10

any charges against students now, maybe involved

9:12

in the encampment? Yeah, the

9:15

university said that the encampment is

9:17

not an arrestable offense, but that

9:19

if it did turn into discrimination,

9:21

violence, intimidation, or any sort of

9:23

harassment, could turn into an arrestable

9:25

offense. As of now, the

9:28

students are facing student conduct violations that

9:30

are internal to the university's review process.

9:32

But as of now, we are seeing

9:35

that the students are not facing any sort of criminal

9:37

charges due to the encampment. Oh, and Dal Camp,

9:39

section editor with the Brown University, Brown

9:41

Daily Herald, concentrating on Polly's side.

9:44

Oh, and best to you, and thank you.

9:46

Thank you. In New

9:49

York City, Mayor Eric Adams is defending

9:51

the NYPD for moving in on student

9:53

protests overnight, arresting almost 300 people

9:56

at Columbia University and the City College

9:58

of New York. He spoke

10:00

earlier at a press conference and, without

10:03

evidence, pointed the blame for the escalation

10:05

of what he called outside agitators. We

10:08

knew and we saw that there were

10:10

those who were never concerned about free

10:13

speech, they were concerned about chaos. It

10:16

was about external actors hijacking peaceful

10:19

protests and influencing students to

10:21

escalate. Columbia has

10:23

asked the NYPD to remain on

10:26

campus through mid-May. Gwen Hogan

10:28

was there last night at Columbia during

10:30

the police response. She's a reporter

10:32

for the nonprofit newsroom The City. She joins me

10:34

now. Hi, Gwen. Hey there. So

10:37

you've been covering these pro-Palestinian protests at

10:39

Columbia for a couple weeks now. What

10:41

do you know about the people who

10:43

had taken over Hamilton Hall on the

10:45

Columbia campus? We

10:48

still are going to be finding out

10:50

information about that in the coming days.

10:52

The mayor has asserted that these were

10:54

outside agitators that sort of fomented the

10:56

protests that were happening on college campuses

10:58

here and elsewhere. At

11:00

a press conference today, he was

11:02

asked repeatedly for specific details about

11:05

this, but he was

11:07

unable to provide some. A police official said that they

11:09

were still sorting through the list

11:11

of arrests to figure out who was and

11:13

who was not affiliated with the universities in

11:15

the other case. We

11:17

heard it's very hard to actually get onto

11:19

campus if you're not a student. Even journalists

11:21

have had a hard time getting on. How

11:23

would these kind of quite-unquite external actors be

11:26

able to get on and be part of

11:28

this? That's right. I mean, at

11:30

the time of this crackdown, press

11:32

were not allowed on campus, had been

11:34

barred by campus security hours earlier. I

11:38

managed to get in. And

11:41

also, I mean, the right,

11:43

you could only enter campus at that point if you

11:46

had an ID that showed you

11:48

lived in a campus dorm. So

11:51

there is a possibility that people had gotten on

11:54

earlier when there was more permeability of the encampments

11:56

and had just stayed for days. So

11:58

there is a possibility. but the vast

12:01

majority of people participating from

12:03

people that I spoke to were students. Now

12:06

videos of the response of the police,

12:08

they're in riot gear, they're using an

12:10

armored vehicle to gain access to Hamilton

12:12

Hall. May Adams describe

12:14

the police responses organized and

12:17

calm. Is that how you would describe

12:19

what you witnessed? I

12:22

think the press's ability to actually witness

12:24

what happened was severely restricted. As I

12:26

mentioned, most reporters were blocked outside. I

12:28

was in a central plaza when police

12:30

entered and very quickly all of the

12:32

students that were on

12:34

that central plaza were forced

12:37

into buildings and barricaded inside.

12:39

So while there was a row

12:42

of about, I would say, two

12:44

dozen demonstrators that remained in front

12:46

of Hamilton Hall, linked arms, and

12:49

those are the students that were arrested.

12:52

It was almost impossible for me to

12:54

observe those arrests. There's some videos that

12:56

show students being flung down or falling

12:58

down stairs, unclear of what happened there.

13:02

Group organizers are saying that some were taken to the

13:04

hospital, but we're still trying to confirm all those details.

13:07

And Columbia has talked about very

13:09

severe consequences, including expulsion for some

13:11

of these students. We know that

13:13

many of the students, students

13:16

of color, coming from low-income backgrounds, they're

13:18

risking a lot. Tell us more about

13:20

them. That's right.

13:22

I mean, a student demonstrator that I

13:24

talked to who was actually acting as

13:27

a negotiator for students who had received

13:29

assurances that he would not face discipline

13:31

because he was trying to act as

13:33

an intermediary between protestors. He was suspended,

13:36

he's a Palestinian student. Some

13:39

of the students are on international visas.

13:41

If they're arrested, that could have long-term

13:44

immigration consequences for them. I

13:46

know that in many movements, they'll try

13:48

to put anybody who's on an international

13:50

visa away from arrest risk, but

13:53

certainly suspension and expulsion is in

13:55

the cards for a lot of

13:57

these students participating, especially those found

13:59

within. Hamilton Hall. And

14:01

just remind us, it's been

14:04

largely peaceful, correct? That's

14:06

correct. I mean the main encampment which

14:08

has been going on for, had been

14:11

going on for almost two weeks, you'd

14:13

see teach-ins, music being played, a lot

14:15

of people praying at various hours, Seder

14:18

dinners among Jewish students and others. It

14:23

was largely a peaceful

14:26

demonstration, mostly

14:28

of students, that's correct. And Gwen,

14:31

let's move quickly to the City

14:33

College of New York. You were

14:35

also there yesterday. Mayor Adams at

14:37

his press conference shared a video

14:39

of the arrests there and it

14:41

ended with officers taking down a

14:43

Palestinian flag and raising an American

14:45

flag. What should we know about

14:47

the context there? Yeah,

14:49

I saw that video also. It was a

14:51

very stark image. I

14:53

had been at that encampment

14:55

before arrests occurred yesterday afternoon.

14:57

It was, you know, these

14:59

are public university students. These

15:02

are working-class New Yorkers who

15:04

were calling for a ceasefire, calling

15:07

for their university to divest from

15:09

Israel because of the war in

15:11

Gaza. And

15:13

so to see sort of this

15:15

image of what evokes a wartime,

15:18

you know, triumph by some

15:21

military against what it was a group of public

15:23

university students, I think it's a very stark image

15:25

to see. Gwen Hogan,

15:27

reporter for the non-profit newsroom, The City

15:30

in New York. Thank you so much,

15:32

Gwen. Thank you. We

15:42

also heard from a student reporter

15:44

in Colorado about encampments there. You

15:47

can hear that conversation at hearandnow.org.

15:50

Coming up next, Robin talks

15:52

with area man Ben Collins, who

15:55

used to report on disinformation, but

15:57

now is CEO of the satire

15:59

publication The truth

16:02

may be stranger than fiction, but

16:04

fiction is more fun. The

16:06

future of America's finest news source when

16:09

we return. I'm

16:15

Myles Parks. I cover voting and election security

16:17

for NPR. Across the

16:19

NPR network, we report rigorously on

16:22

the forces seeking to disrupt democracy

16:24

and provide communities with reliable information.

16:27

It's public media giving days,

16:29

the perfect time to stand with

16:31

the facts by donating now

16:33

at donate.npr.org. Thank

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you. Support

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for NPR and the following message come

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carvana.com or download the app

16:53

today to get started. Taylor

16:57

Swift has dropped a new album. She

16:59

is the biggest pop star in the

17:01

world and everything she does makes news.

17:04

I gasped. I was like, oh

17:06

my God, I've been there and you

17:08

can identify with it. For a breakdown

17:10

of Taylor Swift and her new album,

17:12

The Tortured Poets Department, listen to the

17:14

Pop Culture Happy Hour podcast from NPR.

17:27

The Onion, that satirical news site

17:29

that publishes headlines like, winner didn't

17:31

even know it was pie eating

17:33

contest, has new owners. The

17:36

Onion has been sold to a group

17:38

of anonymous digital media veterans. What is

17:40

known is new CEO is now former

17:43

NBC disinformation reporter Ben Collins. Ben,

17:46

here you are, someone who ferreted out

17:48

disinformation on a news network. What are

17:50

you doing at a site that

17:53

maybe could spread it? Maybe someone

17:55

will believe a man just thought everyone was

17:57

eating pies. first

18:00

instinct is to say if you can't beat them

18:02

join them obviously but I will

18:04

say the onion ironically has

18:06

been even unironically has been the

18:10

most correct paper of my lifetime they were when

18:12

it was deeply unpopular in 2003 where some of

18:16

the first people to call out the Iraq war you

18:19

know you go into now and they

18:21

called out AI and abortion problems that are

18:23

happening like the most recent headline they

18:25

posted about that was Alabama Supreme Court

18:27

rules that frozen burritos or children they've

18:30

been up on the moral panic on trans rights

18:32

all of these things that I would

18:34

say the media has dropped the ball on they

18:37

have been very steady they have

18:39

a very steady moral compass and

18:41

also they are probably the funniest people I've

18:43

ever met so it has been a very

18:45

exciting time entering this writers room this is

18:47

fascinating I mean you mentioned the Iraq war

18:50

this is of course was the war that

18:52

was launched on the false

18:54

information that there were that

18:56

Saddam Hussein had weapons of mass destruction and

18:58

someone was sent to Africa he noted

19:01

to assert that something was made out

19:03

of a material that it wasn't any

19:05

of those things could have

19:07

been satirical headlines but they were true yeah

19:10

on March 26 2003

19:13

they posted a point counterpoint that

19:15

was settled this war will destabilize the entire

19:17

Middle East region and set off a global

19:19

shock wave of anti-americanism versus no

19:21

it won't which is exactly

19:25

the fight we were having back then yeah

19:27

and and you see a lot of the

19:29

echoes of that now you know we've been

19:31

seeing a lot of the stuff around

19:33

protests around Gaza that this group

19:35

has a very finely

19:38

refined bit of moral

19:40

clarity and that's because the editor-in-chief of the onion

19:42

has been here for over 20 years people

19:44

really love this thing they believe in what

19:46

it is and also we make

19:49

really stupid jokes too just all the

19:51

most this incredibly serious I have a

19:53

few here you want to hear them I

19:55

love to hear them study reveals babies are

19:57

stupid There's

20:01

that, but tell me more about what

20:03

you see as something that maybe

20:06

undergirds what you do, which is

20:08

pointing out absurdity or disinformation. Tell

20:12

me more about what you see. Like,

20:14

for example, even on the stupid

20:17

stuff, even on, say, like Aaron Rodgers, the

20:19

anti-vax quarterback of the Jets, we

20:21

have a headline that says, resilient Aaron Rodgers vows

20:24

to return more detached from reality than ever, that

20:26

sort of thing. We're removed. And

20:29

that really helps. And that's

20:31

in part because of the process here. I just want

20:33

to talk about this. It's kind of an incredible bit

20:35

of magic they have, where they

20:38

toss every week hundreds of

20:40

headlines into a Google Doc. Those

20:42

headlines are anonymized. Then they go in the room and they

20:44

talk through them to see what's the best, how they can

20:47

work through them together. They do this every day. And

20:49

then they go back and they find out who wrote it afterwards. Some

20:52

of those are from old Onion

20:54

alumni from 15, 20 years ago that

20:57

still send in headlines. Like

20:59

these guys are like one of

21:01

the last meritocratic, truly, parts

21:03

of American journalism and American life.

21:07

It's really special to be a part of it. And

21:09

that's how it's remained this funny for so

21:12

long, is that it's completely unpretentious and it's

21:14

really, really stupid. Give

21:16

me a couple more examples of

21:18

where you think the Onion will

21:21

continue digging in a way that maybe you do in

21:23

reporting on disinformation. Disinformation

21:27

won. There's no other way to put it. Elon

21:30

Musk sort of won the pipeline war with

21:32

Twitter and then he turned it into a

21:34

weird spammy bot website

21:37

where lies and conspiracy

21:39

theories won out. Disinformation

21:41

won. And the best way to fight in

21:43

this moment is to take that

21:45

language, take that verbiage of disinformation, but kind of

21:47

tell the truth with it. And

21:50

that's why we got into this. Let me

21:52

ask you, just in the minute we have here, is

21:55

this why you've made the switch, Ben Collins?

21:58

You're now the former disinformation reporter. Is it

22:00

because there's so much disinformation out there and

22:02

disinformation as you said has one and To

22:06

report on disinformation is often to spread it

22:08

by its nature But this

22:10

may be at the onion you

22:12

you know again, you're not writing this stuff

22:14

But it's you're helming something that

22:16

is maybe even a better way at going at disinformation

22:20

Yeah, exactly. I mean we got this thing to get out

22:22

of people's way You know

22:24

this this is an institution We think it's

22:27

an important part of American life and

22:29

we think we'll just be garbage to go through an election without

22:32

The onion like our whole goal with

22:34

it is to make sure more people see onion headlines. That's

22:36

it. Like I'm not I Am

22:39

just a fan who is now Able

22:42

to tweet their stories more and try to get them

22:44

on television and do all that stuff So that's really

22:47

my whole goal. They have been The

22:50

best truth tellers of my life. It's in

22:52

their own way. Obviously at least

22:54

that's on purpose. I think that's the difference

22:57

Here's my favorite headline kitten thinks of

23:00

nothing but murder all day My

23:03

favorite ones obviously I can't repeat Then

23:06

Collins new CEO of the onion

23:08

former NBC disinformation reporter Ben. Thanks

23:10

so much. Absolutely. Thank you If

23:15

I start listing onion headlines I'm gonna be here all

23:17

day Juris

23:21

prudent fetishist gets off on

23:23

technicality Come on genius

23:27

Coming up a retired medical

23:29

director is blowing the whistle on

23:31

her former employer Signe claiming her

23:33

bosses cared more about being fast

23:35

than being right Robin

23:38

has the story after the break There

23:45

are a lot of issues on voters minds

23:47

right now six big ones

23:49

could help decide the election guns

23:52

reproductive rights immigration the

23:55

economy health care and the

23:57

wars overseas on the consider

23:59

this podcast from NPR, we will

24:01

unpack the debates on these issues

24:03

and what's at stake. You can

24:05

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Keep that service strong with a donation

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24:25

thank you. Desmond

24:28

Morris here from the StoryCorps podcast. Our

24:30

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Over the past couple decades, the US has

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NPR network stays strong by supporting

25:09

us at donate.npr.org. And

25:12

thank you. Most

25:22

jobs have some way for bosses to

25:24

track the productivity of their workers, how

25:26

many products shipped out the door, how

25:28

many cases are cleared. But

25:31

the crash necessities of business take on a new

25:33

light when you're talking about health care. A

25:35

retired medical director is now blowing the

25:38

whistle on her former employer, Cigna, claiming

25:40

her bosses cared more about her being

25:43

fast than being right. She says the

25:45

mantra for people processing medical insurance claims

25:47

was deny, deny,

25:50

deny. David

25:52

Armstrong reported on this disturbing news for

25:54

ProPublica. He's here with more. David,

25:57

welcome. Thanks for having me. And this is

25:59

truly disturbing. reported this along with Patrick

26:01

Rucker of the Capital Forum. It

26:03

centers on Dr. Debbie Day, who

26:06

retired in 2022. But before she

26:08

left Cigna, Dr. Day said Cigna

26:10

tracked every minute that she spent

26:12

deciding whether the company would cover

26:15

patients' claims, and that

26:17

the company then shared productivity dashboards

26:20

that put pressure on employees to clear

26:22

claims quickly. And of course, the quickest

26:24

way to do that is to deny

26:26

them. You actually saw some

26:28

of these dashboards. What did they look like? And

26:30

what was she being told to do? Sure.

26:33

So these dashboards were sort

26:36

of elaborate spreadsheets with dozens

26:38

of columns tracking every kind of

26:40

case that the medical directors who

26:43

are doctors working for the

26:45

insurance company to decide if you should

26:47

get care that your doctor has described.

26:50

And it also had a number at

26:52

the bottom of each column on how

26:55

much time on average these decisions should

26:57

take. And at the

26:59

very end of the spreadsheet was

27:01

a rating percentage calculated based

27:04

off how many hours they worked. So the

27:06

more cases you did, the higher the rating

27:08

you got. And all the doctors at Cigna

27:10

saw this rating. And what Dr.

27:13

Day and others told us was the

27:16

impact of this was to increase

27:19

speed, to do cases quicker, faster. And

27:21

she was told this and actually put

27:23

on a performance improvement plan with a

27:25

dire warning that if she did not

27:27

do cases faster, she was going to

27:29

be fired or face the threat of termination,

27:32

I should say. And we need to

27:34

underscore, as you said, Dr. Day. She

27:36

is a doctor and is employed because

27:39

of her medical expertise to figure out

27:41

if claims should be

27:43

honored. And you write, Day

27:45

was in her own words, persnickety,

27:47

I would say thoughtful. But

27:49

if a nurse recommended denying coverage for a

27:52

cancer patient or a sick baby, she wanted

27:54

to be certain. It was the right thing

27:56

to do. So she'd research guidelines, read medical

27:58

studies, scrutinize, patient medical records to

28:01

come to the best decision and this took

28:03

time, she was then clearing fewer

28:05

cases than many of her peers. Tell

28:07

us a little bit more about her and how

28:10

she worked, you know, what her job was. Sure.

28:13

So she, you know, like many of the

28:15

medical directors, reviewed all sorts of cases. So,

28:17

you know, common in health insurance

28:21

is a concept called prior authorization.

28:23

Your insurer is not going to pay for

28:26

care until they say that it's appropriate or

28:28

medically necessary is the term that's often used.

28:31

So these are things like MRIs or surgeries,

28:34

everything from, you know, a spine surgery

28:36

to a hip implant to a stent

28:39

in your heart, for instance, if it's

28:41

non-emergency, to prescription drugs,

28:43

especially expensive ones. So she would

28:45

review these cases and the

28:47

way she tells it is she took this

28:50

review very seriously. You know, this is

28:52

a physician prescribing care for a patient

28:55

and if she was going to deny it and say that

28:57

it's not appropriate, she wanted to make sure she was on

28:59

very firm footing and that this

29:01

was a legitimate denial and

29:04

there's a good basis for it. And that took time

29:06

and she did things like review

29:08

all the medical records, look at studies. These

29:11

cases come pre-prepared by nurses and in

29:15

the case of Cigna, they used quite a

29:17

few nurses overseas to do this work. And

29:20

what Dr. Day said was less

29:22

scrupulous doctors, colleagues,

29:25

would simply adopt the language of

29:27

nurses who recommended something be denied

29:31

and go on to the next case. This is

29:33

a concept known as click and close because that

29:35

was a way to keep up with your numbers

29:37

but in her mind, not share the patients. Well,

29:39

you mentioned nurses. There was a team of Cigna

29:42

nurses in the Philippines, for

29:44

instance, and there's no pejorative to be read

29:46

into that. But Dr.

29:48

Day said she was catching errors in

29:50

their patient files, glaring errors, wrong

29:52

name, wrong body part, wrong disease. She

29:55

said her bosses didn't want to hear about it. You know, it makes

29:57

you wonder if the nurses, that particular group, were able to do that.

30:00

of nurses were really nurses, or

30:02

if there's a sense that everybody's going along to get along,

30:04

I mean, you talk to other employees

30:06

independent of Dr. Day, what

30:09

did they say? Well, they,

30:11

they, they, and also we had some

30:13

evidence of, in emails and, and other

30:16

documents where other medical directors were complaining

30:18

about the work of the overseas nurses.

30:20

Now, for sure, domestic nurses can make

30:22

mistakes too, and they did. But

30:25

there seemed to be a higher rate when

30:27

they started contracting with offshore nurses.

30:30

One other medical director called their report MESSES.

30:33

Another one we saw said that they

30:35

were very concerning the, the poor quality

30:37

of the work they were seeing from

30:39

there. And of course, if you don't

30:43

rigorously check the work of those nurses,

30:45

and there's mistakes in there, it could

30:47

cause somebody to be denied care when

30:50

they should have received that care. So

30:52

one would, you know, think, again, without

30:55

broad brushing nurses in the

30:57

Philippines, there's not a

30:59

lot of oversight of this particular group of

31:02

nurses that was working for Cigna if you're

31:04

not overseas with them. Why were claims

31:07

being processed overseas? We

31:09

don't know. And Cigna

31:11

hasn't spoken directly to that. You know,

31:14

when companies traditionally go overseas, it's usually

31:17

to save money, to realize

31:19

some efficiencies from, from doing the work

31:21

outside the US. We know

31:23

that some other insurers have done this as well.

31:25

So I suspect that's the

31:27

reason, but we don't know for sure. Well,

31:30

Cigna has responded to all of this.

31:32

They called Dr. Day a disgruntled former

31:34

employee, told you there's no

31:36

rubber stamp for denials. What else

31:38

did they say? Well,

31:41

they said that they actually argued that it would

31:43

be easier for doctors

31:45

to quickly accept recommendations

31:47

rather than deny them, which

31:50

the medical directors we spoke to disagreed

31:52

with that. They said it was much easier to

31:54

just simply cut and paste the language the nurse

31:57

had suggested to deny something and move on to

31:59

the next case. And

32:01

they said that there's no tolerance for that kind of

32:03

activity we described if it was going on, that

32:05

doctors are expected to do a

32:08

thorough objective review, you know,

32:10

that's not dependent upon solely the

32:12

nurse's summary of the cases. So

32:14

they did push back on that. But they

32:17

did acknowledge that in Debbie

32:19

Day's case that the dashboard, the

32:21

productivity dashboard was used to

32:24

evaluate her performance. They said

32:26

it generally isn't. And we also found

32:29

some evidence that the dashboard was tied

32:32

to bonuses. There was an email from a

32:34

supervisor saying that it was at least a

32:36

component of how bonuses and stock awards and

32:38

things like that were handed out. Yeah, well,

32:40

and it gives more incentive

32:43

to people to do it quickly,

32:45

although there is some value to

32:47

processing claims quickly, we know that.

32:49

And there is value to measuring

32:51

employee productivity. But we're

32:53

talking about healthcare, right, which, you know, means

32:56

that incentivizing people to go quick can have

32:58

a real serious consequence. So is

33:01

there a sense that Cigna or the

33:03

wider healthcare industry might

33:05

be looking at a way to change this? I

33:08

don't have a sense that that's the case. And you

33:10

know, you mentioned the wider industry, there is evidence of

33:13

someone's behavior occurring at other insurers. We

33:15

wrote a story last year about UnitedHealthcare.

33:18

And one of the medical directors there testified in

33:20

a court case that he always

33:22

just accepted the nurse's recommendation that he never

33:24

did his own independent review. He literally said

33:26

that I just make sure there wasn't a

33:28

decimal place that was out of line. And

33:31

then the medical director a couple of years ago

33:34

testified that he didn't independently look at the medical

33:36

records when cases came in from nurses. So this

33:39

may be an industry-wide thing. You

33:41

know, you make a good point that these cases

33:43

need to be decided in a timely way, right,

33:45

people are waiting for medical care. Dr.

33:48

Day and others would say that's true,

33:50

but the answer is hiring more doctors,

33:53

not forcing doctors to make quicker decisions

33:55

that might disadvantage the patients who are

33:58

desperately seeking this care. Well

34:00

meantime, what should consumers do? You know, if you're

34:02

thinking, wait a second, come to

34:04

think of it, I had a claim that I

34:06

felt really should have been honored. Do

34:09

we have any recourse? Consumers

34:11

do have recourse. You can

34:13

appeal a denial first to the insurer

34:15

and then there's often mechanisms to appeal

34:17

beyond that to independent authorities. Very,

34:20

very few people ever do that. Some

34:22

studies have shown one to 2% of

34:24

denials get appealed. What's interesting

34:26

is when you do appeal, you

34:28

have a pretty good chance of overturning it. You

34:30

know, one study found I think 50% of denials

34:35

when appealed were overturned. It's a very small

34:37

number because only a few people do it.

34:39

But people should consider doing

34:41

that. If you and your physician

34:43

think that this has been done unfairly or

34:45

wrongly, you should appeal because

34:48

you might have a chance of getting that care paid

34:50

for. ProPublica's David

34:53

Armstrong will link you to his story

34:55

at hearingout.org. David, thank you. Thanks

34:57

for having me. That's

35:03

our show. Here and Now Anytime comes from

35:06

the team behind Here and Now from NPR

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and WVUR. Today's stories were

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Susana, Ashley Locke, Gabrielle Hee-Wee, and

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Green. Mike Mosqueto also wrote our

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