February 21, 2019

Working for Health Insurance – Is This Really the Dark Side?

doctor with brief case pixaby

“Work for a health insurance company? You mean go to the dark side? No thanks!”

This is what I hear a lot from my clients who are considering a non-clinical career. However, with the way things are going in medicine, some are reconsidering. They are willing to temporarily suspend judgment to at least learn about this area. What they are finding out is the dark side is not necessarily so dark after all.

To get the inside scoop, I interviewed one of my awesome clients who generously agreed to share her experience working for a major health insurer. For the purpose of this interview, I will refer to her as Dr. Crawford (not her real name).

Background: Dr. Crawford is board certified in internal medicine and practiced for over 10 years before transitioning into the health insurance industry.

HF: What is a typical workday like for you?
Dr. Crawford: I work from home, usually 8 am – 5 pm. I take an hour off for lunch. My work focuses on Medicare inpatient claims. I participate in case management rounds. These are generally for chronically ill patients that are in the hospital a lot. Nurses prep the information for me and we do rounds on the phone. A lot of times there are crazy social issues. There was a patient who had some medical and psych issues. The hospital tried to place him in 40 skilled nursing facilities to no avail, as no one would accept him due to behavioral issues. We had to push the case managers at the hospital to get him a guardian since his family was not caring for him. Finally they were able to place him in a nursing home. I also do some appeals for cases that have been denied and a few pre-certifications.

HF: Are you required to go into an office at all?
Dr. Crawford: No. I don’t go into an office. Instead, there are occasional meetings in surrounding cities where I learn about new Medicare policies and anything that affects my workflow. This is when I see my other team members. I work with 2 family practitioners and one oncologist.

HF: How do you deal with doctors who are angry because you are questioning their treatment plan or denying something?
 Dr. Crawford: I tell them I understand your frustrations and how with discharge plans social issues can get in the way. I don’t always nitpick down to the minute criteria. I let them know I understand that these things can come up with older folks, that I used to take care of them. It is only rarely that I have to speak to doctors who are upset. I’ve probably had 2 in the past 10 months. Of my cases, only about 10% require a peer-to-peer where I need to speak to the physician. One guy threatened to sue me personally for my decision. I said OK I am going to end this call because you are repeatedly threatening me and let him know of his right to appeal the decision.

HF: What do you like about your job?
Dr. Crawford: I love working at home. I like my team. I like my superiors and the management structure of the company. They take your concerns into consideration and try to make it work for you. The benefits and pay are really good. I enjoy getting to use my medical knowledge. It’s not a simple job, but there is so much less stress than when I was in clinical practice.

HF: What don’t you like about your job?
Dr. Crawford: There is a lot of typing and mousing. I was having trouble with my wrists before and I still do…I get up and take some breaks and move around.

HF: How are you treated?
Dr. Crawford: Really well. In my last job I was a corporate employee. This is vastly different experience. I was warmly welcomed. I have one-on-one meetings with my boss. When I was in practice as a corporate physician, they always forgot Doctor’s Day. This year I received 42 Happy Doctor’s Day emails. It’s a much better feeling.

HF: What kind of compensation could a doctor anticipate for an entry-level position?
Dr. Crawford: $200 – $220K. There are lots of good benefits. We have a nice 401K match, annual raises, a generous yearly bonus. Health insurance, dental, disability, some employee discounts. EAP. Financial counseling. 23 days PTO, 5 days CME, CME stipend and malpractice coverage

HF: What advice would you give other doctors who are interested in working for a health insurance company?
Dr. Crawford: I would not discount it based on any preconceived notions about insurance companies. I have always felt that the criteria they have is based on sound medical evidence. It made sense to me. I found it to be clinically sound and sensible. I never thought, “I can’t believe they are doing this.” My boss is always telling me, if there is any question in your mind, always err on the side of the patient.

HF: What are the opportunities for advancement?
Dr. Crawford: I could move up and become a senior medical director and then a regional medical director. I don’t think I want my boss’s job. There is a lot of HR you have to do in addition to regular job. They are big on career development. You have two reviews a year and you need to write down your goals and how you will accomplish them. They suggest you find a mentor in the company for support and guidance. One other area that medical directors can be involved in is the medical policy department.

HF: Do you see yourself doing this job long term?
Dr. Crawford: Yes I hope I can do this until I retire.

HF: What kind of doctor would make a good fit for this kind of work?
Dr. Crawford: Anyone who would appreciate the lifestyle improvement and doesn’t need to continue clinical care. There are all specialties. As long as they maintain board certification. We have a lot of primary care physicians, including pediatricians, as well as OB/Gyns, an anesthesiologist, a spine surgeon, one neurosurgeon, a dentist, and a pharm D.

HF: What kind of doctor would not be a good fit for this kind of work?
Dr. Crawford: One who wants to be clinical or who is not a team player.

HF: How is this job different than you expected?
Dr. Crawford: Much better than expected. Great company. They take their employees’ concerns into consideration. They have their HR stuff straight. There are less issues than at my last company. I have not found anything wrong in their policies.

HF: How much do you enjoy the work you are doing?
Dr. Crawford: It is not always the most intellectually stimulating, but I am reading medical cases, and applying the criteria. I get to use my medical brain. I won’t say I am passionate about it. But it is doable and easy.

HF: Do you miss anything from your previous work as an internal medicine physician?
Dr. Crawford: No!!!!!!!!!!

Dr. Crawford’s job focuses on Medicare patients in the hospital setting. A physician working for the commercial side of insurance, and with outpatients, will have different duties. For those interested in applying for a health insurance position, the general requirements are 3 – 5 years clinical experience, active licensure, and board certification. It is helpful to have some type of utilization review or management experience, but this may not be necessary.

 

 

Comments

  1. Antoinette says:

    What are some companies to work for in this capacity and how do you find the work?

    • Heather Fork says:

      Any health insurance companies, such as Humana, Anthem, Aetna, Bluecross Blueshield, etc. You can search the company website as well on job sites such as indeed.com and glassdoor.com, and others.

  2. I find it interesting that the physicians “policing us” make more money working 9-5 than the physicians actually doing the care. It just seems wrong.
    Tracey

    • Heather Fork says:

      Thank you for your comment Tracey. I can understand your feelings. Many doctors are underpaid, and do so much for free. Lawyers would never do all of the free things that doctors are asked to do, such as phone calls, and now texting and emailing. There are a lot of problems inherent in a system where there is third-party payor for services, and most people can’t afford to pay their own medical expenses if they are seriously ill or injured. It has created the need for all these layers of bureaucracy, which in part has resulted in decreased reimbursement for those actually taking care of the patients. There are a lot of plumbers who make more than physicians.

  3. Heather says:

    Does anyone know the movie where a female doctor left that business and worked for an insurance company and then left to start her own business

  4. Maria de la Cruz says:

    Would a recruiter be of any benefit to find these positions?

    • Heather Fork says:

      Hello Maria, Thank you very much for reading and for your question. Recruiters can be helpful. You can find them sometimes on LinkedIn by searching for physician recruiter matched with a variety of health insurance companies and also searching on your state. There are also some independent recruiters who are not affiliated with a specific insurance company who do recruiting as well. They can be a bit harder to find, but searching on different terms such as physician recruiter, health insurane, medicare, utilization management, etc. may produce some results. Heather

  5. Would you ever work for an insurance company and declare a person not disabled because you were told to, even though they were

    • Hello Tammy, thank you for reading and asking a good question. My answer is “absolutely not.” As a physician, our duty is to the patient and whatever determinations we make need to come from an unbiased review of the medical history, examination and studies. When we make a determination, we have to sign our name saying that is our decision and know that we make that decision in full integrity. I am curious if you know of someone who has had this experience?

  6. Adriana Canas-Polesel says:

    Hi Dr Fork

    I just signed on to work for Anthem as a medical director. I went to the SEAK conference in Chicago in October. I’ve been thinking about leaving clinical medicine for some time. I love my patient care and interactions it is just the mental exhaustion I’ve experienced and the lack of being able to shut off completely when not at work. It helped me a lot to listen to the presenters at SEAK regarding their experiences and how varied the jobs they have taken are. At first I was afraid to work for an insurance company as it is the dark side of medicine but talking to other doctors and actually knowing 3 physicians who made this transition 3-5 years ago has helped me understand the role better and they feel they are helping patients in a different way. I also thank you for your inspiring presentation at the SEAK conference

    • Hello Adriana,

      Your timing is impeccable! Today I had a planned call with the physician who presented on Health Insurance at the SEAK conference, and I passed on your message and good news! He was happy to hear that you found the conference helpful in opening the doors to a new perspective on working for Health Insurance, and that you have found a position. Congratulations! I hope you have a great start at Anthem and wish you well. We would love to hear back from you in 6 months if you would like to share an update. Thank you for reading on The Doctor’s Crossing and commenting, and your kind words about my presentation. Happy Valentine’s Day, Heather

    • Ann Shang says:

      Hi Adrianaa,
      Did you land the job through a recruiter or another venue?
      Thanks,
      Ann

      • Hello Ann,

        Let me see if I can find out that answer for you. From my experience with my clients, some apply directly to postings listed on indeed.com or the company’s website, and some through recruiters. Heather

        • I have not seen the appropriate listing on the company websites. I think recruiters would have the better access or they can direct me to the right people. Thanks for checking Heather.

          • Yes good idea to connect with recruiters, they definitely have the insider tract, and as positions are available, some companies will post the positions on their sites, as well as on indeed.com and other job sites.

      • Hello Ann,

        I am a board certified pediatrician who made the transition into insurance medicine as a medical director. During my job search, I connected with several recruiters through LinkedIn. Most accepted my connection but never responded to my inquiries. I did receive responses from a few, and even a phone interview with one recruiter, but ultimately these connections never led anywhere. In the meantime, I also repeatedly applied for positions that were listed on LinkedIn, Glassdoor, and the career websites from the insurance companies themselves. It was a very frustrating process.

        I ultimately began to connect with medical directors in leadership positions through LinkedIn. Any time I completed an application, I would try to find both a medical director and recruiter for the company I had applied to and follow up with them on my application. It was one of these connections that eventually led to my first interview, several months after I started my job search. This interview ultimately led to the position. The moral of the story is to network as much as you can and keep trying. These positions are much more competitive than clinical positions, and persistence is also key.

        • Thank you David for sharing this very helpful information about your personal experience finding a position in insurance medicine. Congratulations to you. Persistence really does pay off. I’m impressed with your creativity and stick-tuitiveness. Other approaches that I have seen increase one’s chances is doing chart reviews and other U/R work on the side, as an independent contractor or PT employee. Recruiters and Hiring Authorities look for this experience as the work is often what one would be doing FT in an insurance job. If you are doing chart review, and liking it, the hiring company has more assurance that you will like working for them. Also, at the SEAK Non-Clinical Careers Conference, there are recruiters from insurance companies as well as Independent Review Organizations (IRO’s) and other chart review companies. Making an in-person connection at the conference can really help with getting hired!

  7. Dr. Rajgopal. V says:

    Hello Heather.
    I need an urgent favor from you. I am now over 15 years in clinical medicine and tired of it. I am a GP and would like to shift to the health insurance sector. I am an indian citizen but living and working in Kenya. I also have some 4 years experience in the pharmacy industry. Where can I get information about jobs in health insurance (medical director or advisory roles)? Your help will be very much appreciated.

    • Hello Dr. Raj,
      I am very sorry to hear how burned out you are feeling. I can appreciate your feelings and strong desire to find some non-clinical options.
      Were you looking for jobs in Kenya? Where was your work in the pharmacy industry. If you could give me a little more information about where you were thinking of trying to find a non-clinical role, that would be helpful. Kindest regards.

  8. Dr. Rajgopal. V says:

    Continuing from the above comment I am now suffering from an acute burnout and can’t face seeing another patient!! I am keen to explore offers in Dubai or Europe or Singapore.
    Thanks.

  9. AD Clinician says:

    What are the entry level positions called (meaning what do I search for on these sites) for MDs looking to transition into the insurance field?

    • Hello Audrey, the positions are usually titled, “Medical Director.” You can search on the individual company sites, such as Anthem, Cigna, etc. You can also look on indeed.com.

  10. This is very interesting. We have 2 children in toddler age (I’m in my early 40s). Tiring of clinical medicine and hoping to homeschool. Would this be a good transition?

    • Hello Ida,

      Thank you for reading and commenting on the blog. If some of what you read in this blog sounds interesting to you, then working for us insurance company might possibly be a good fit for you. As you might expect, physicians who work for insurance companies have different experiences and some find the environment works well for them and others decide that it’s not their cup of tea. If you are considering this possibility, it’s good to talk to a number of doctor’s who are working for insurance/managed-care and then draw your own conclusions. You could also do a total debt by trying out chart review as an independent contractor which can be similar to the insurance work and see how you like that. Good luck to you!

  11. Hi, I am a GP who is looking for further degree after getting MBBS and 3 years practice, recently I am working as a medical director (they call it here insurance physician) in a healthcare provider, any suggestions?

    • Hello Ala, thank you for your inquiry. You mentioned you are looking for a further degree after getting your MBBS, and that you are working as a medical director. Could you kindly give me a few more details about your situation and your goals? Are you wanting to continue to work in insurance medicine? Are you in India? Do you know what your additional degree options are? Thank you in advance for the additional information.

  12. Catwoman says:

    People who are not seeing the patients are deciding who should have the Ct or MRI and people like us who sees the patients has to beg. Scary. But that s what the medicine has become

  13. Catwoman says:

    My hubby is a psychiatrist and I m a primary care physician.when we all became doctors, we promised to take care of the patients and be their voice if they are in trouble. I think it s ok to do any job but we have to be able to sleep at night. There will be a reaction or karma waiting for us at the end and there are many examples in real life.
    I am a partner in a group. We are busy. We forget to say happy doctor s day sometimes. Because we are so busy taking care of patients in need. It shouldn’t matter if patients don’t know or others forget about doctor s day. My conscience is clear and I m still a doctor whether it s doctor s day or not! Medicine has changed so much though.

    • Happy Belated Doctor’s Day Nilar. It sounds like you have a heart for taking care of patients and being their advocate. I applaud your effort and commitment. Being a doctor does have a lot of challenges, increasingly so, and each person has to find the right environment to care for patients and not become burned out and cynical. Wishing you and your physician husband all the best in your practices.

  14. Hilari L Fleming says:

    I am very interested in finding this work. at age 61, i need to slow down from neurosurgical clinical work. Are there jobs for neurosurgeons with extensive clinical experience and how can I find them? I’m not sure how they are posted, and generally just find clinical jobs. Thanks!

    • Hello Hilari, you have a very challenging specialty, and I can understand why at 61 you would want to titrate down on your clinical practice. In general, health insurance companies hire primary care physicians for their full-time positions, but some do hire specialists, including surgeons, although this is less common. Some third party companies that do benefits management/utilization review for insurance companies may specifically advertise for neurosurgeons, especially spine surgeons. These third party companies (also know as Independent Review Organizations) often hire neurosurgeons to be on their panel of reviewers, and this kind of work comes under the umbrella of “chart review” and can be done as an independent contractor on a part-time basis. Some insurance companies may contract with neurosurgeons on a part-time or as needed basis for reviews. One of the best sites I have found for these non-clinical positions is on indeed.com. Other areas to consider – Expert Witness, Independent Medical Exams (IME’s), Worker’s Comp and Disability reviews, Medical Writing and Consulting.

  15. Jodi Shields MD says:

    I am a physiatrist, board-certified for 20+ years. A great deal of my work has been with worker’s compensation, veterans, lots of depositions, and now a lot of writing. I would LOVE to get out of doing any more patient care because I have found it increasingly unsatisfying. I have excellent writing and presentation skills and am, as a physiatrist, definitely used to being a team player in all aspects of care. Where would you recommend I start? Thanks, in advance, for any advice you can give me!

    • Hello Jodi, it sounds like you would be an excellent candidate to work for a company in the area of disability determinations, if this were of interest to you. There are jobs both in the private sector and for the government. Your clinical background in physiatry with board certification and 20 plus years experience, combined with excellent writing skills make you a very strong candidate. From what it sounds, you should be able to find PT or FT work that is completely nonclinical. For more information, please feel free to reach out to me at heatherfork@gmail.com or through my website, http://www.doctorscrossing.com

  16. Melanie Simard says:

    Hi,
    I just moved to the US. I worked as a family physician in Canada for 6 years, doing mostly in-patient (what is called an hospitalist here I believe) and some office work as well. I could get my right to practice in the US without any additional exams or anything but I am not sure I want to go back to clinical practice as things are a bit different here.
    That being said, I am considering all my other options now and working for an insurance company is definitely one of them. How much do you have to know about the US insurance system before you can get a similar job ? Do you think I would still have a chance to get a job if I apply even if I have not worked in the US ? What are your thoughts ?
    Also, since you work from home, I am guessing that you can work for companies that have their offices based pretty much anywhere in the country without having to move there, is that right ?
    Thank you so much for your help. Feel free to give me any additional information that you might think is useful.

    • Hello Melanie, I apologize for the delay in answering your question. I was at the SEAK NonClinical Careers conference this weekend, but I did have the chance to speak with two recruiters about your question. They both work for health insurance companies. They said that if you have a US license and live in the US and have board certification, you would potentially be eligible to work for a health insurance company. To be competitive with other applicants, it is helpful to have experience doing “chart review” which involves utilization review, medical necessity, peer and quality review work, as well as being on a utilization review, quality or peer review company. Some companies offer remote options, others have you go into the office periodically, and some are fully on-site. Hope this helps!

  17. Hi Dr.Fork
    I just moved to US and am board eligible in orthopedic from Saudi Arabia but not yet had the exam.
    I didn’t set yet for USMLE.
    Can I get tgis type of work without USMLE

    • Hello Emad, thank you for reading. You would need to have a US license to work in the capacity of a physician medical director for a health insurance/managed care plan. Most also require board certification. Some smaller plans will accept board eligibility. Hope this helps!

  18. Hi. Very informative blog. I was wondering if there are any positions available to radiologists with insurance companies. And if not, any other non-clinical opportunities? Thanks!

    • Hi Mick,

      Thanks for reading and for your question. While some insurance companies focus on primary care specialties, others are much more broad-based in their hiring and do employ radiologists. Radiologists can be very helpful in utilization review and benefits management, as well as protocol and guideline development. I don’t know of any health insurers who are currently hiring radiologists but checking with recruiters from the various companies could be useful. You can often find recruiters by searching on LinkedIn. There are a number of companies that hire radiologists for benefits management of imaging studies, such as AIM Speacialty Health which is a division of Anthem. Magellen Health and Evicore also come to mind. You could consider companies that service and manufacture imaging equipment and mobile MRI companies. Good luck!

  19. I currently am board certified in general pediatrics and completed a general peds residencty, but went on to a subspecialty fellowship, and have three years post-fellowship experience in that field. I will be sitting for my subspecialty boards in the coming year.

    Are there job opportunities for somebody with my certifications/experience?

    • Hello Mike, to answer your question, yes, there should be opportunities in health insurance/managed care for you. Having the general pediatrics experience, as well as subspecialty training and expertise is a good combination. If you can add in some experience (if you don’t have it already) doing chart review as well as serving on committees such as quality and peer review that can be helpful. It can also give you an idea of how much you like this work. Because pediatrics in general is not where the big expenses come in for health plans, there is not as high a need for pediatricians as there would be for internal medicine physicians or oncologists, but there is still a place. Thank you for reading and good luck to you!

  20. I’m an OBGYN 6 months out of residency. Do you think there is any chance of finding this type of work this early in my career? Are there any certifications or additional training that would be worth me looking into?

    • Hello Jack, most health insurance/managed care companies want their physician medical directors to have 5 years post-residency in order to apply. They also strongly favor and often require board certification. The state you are licensed it can also make you more or less competitive depending on where their current needs are. Large population states such as TX, CA, FL and NY are often seen as desirable, but it can also just have to do with the company’need at the time. One of the best things you can start doing is getting experience with chart review. This can be Utilization Review and/or Disability and Worker’s Comp. Some companies do require a certain number of years post-residency to do there review – others do not. Getting on a utilization review, peer review or quality committee in your hospital system is also good experience. Anything that gives you some management or leadership skills beyond clinical practice is helpful.

  21. As a chiropractor with extensive background in impairment ratings for both the worker’s comp side as well as independent ratings and consultation for personal injury attorneys on how to increase the value of cases while dealing with insurance company valuation software such as Colossus, where would I fit in when looking for this type of position?

  22. Could you please give an example when a board certified US physician with 5-10+ years of experience ordered something after face-to-face patient care, and you corrected it (denied coverage) based on remote reviewing of his notes?
    From all my previous experience, a position like a medical director is created to save money for an insurance company. Doesn’t it mean “a team player”? There is a direct conflict of interest.
    I would possibly agree that a young fresh doctor might need some supervision from an experienced mentor from the same specialty with a good teaching feedback.

    • I do not personally do reviews as a medical director but I speak with a lot of physicians who are medical directors and by and large their goal is to serve the patient and try to do what is best for optimal and appropriate care. They do need to work within the guidelines of the patient’s insurance plan, but there can also be given and take here depending on the situation. They have told me that when they do peer-to-peer calls, some physicians have even been grateful when they are able to recommend a study or treatment that is actually better for the patient than what they were intending. It is a given that in managed care, some treatments and procedures are denied when that is not in the best interest of the patient, due to coverage policies, but this is not the status quo and not the intent of good medical directors. You are correct that our system has a lot of problems and we have not found the solution. How to give the best patient that is cost-effective and a wise use of resources will be a questions we continue to try and answer for the foreseeable future.

  23. Dr. Nguyen says:

    Which insurance company does Dr Fork work for?

    • This is Heather Fork and I do not personally work for an insurance company. I do career coaching for physicians. Dr. Crawford (not her real name) is the one who works for the insurance company. The company is one of the major insurers, eg. BlueCross, Anthem, Cigna, UnitedHealth, Aetna. I was asked to keep the specific company name confidential.

  24. Aabshar says:

    Hello Heather,
    I completed my general surgery residency from India. Currently am doing MBA from a top 20 B school in US. Last week I was approached by Mutuals of Omaha for an informational interview. After reading your blog I have an understanding that I can’t work with them as a medical director as O don’t have US license. Please help me understand the positions they might be contacting me for. I still have my interview due.

  25. Aabshar says:

    I have the interview on Friday. Will be asking questions during the interview. Only thing they mentioned was opportunities in financial advisory. Am trying to read more and more to understand that could possibly mean in my case.
    Thank You for guidance. Much appreciate.

  26. Thank you for the informative article. Are there any opportunities for Gastroenterologists?

    • My pleasure. If you polled all of the major health insurance companies, you would find that they hire from a range of different specialties. The majority will often be IM and FP, however, they do need specialists to round out their teams and expertise, hence there are also psychiatrists, surgeons, Ob/Gyns, peds, neurologists, subspecialties of IM such as GI, Cardiology, oncology, etc. When a company hires a specialist often depends on which specialties they already have and what kinds of cases they are getting for review. To be as competitive as possible, it is helpful to have some experience in chart review/utilization management, quality, peer review, etc. State licensure can make a difference as well, since the company may be looking specifically for a certain state license. The more populated states such as CA, TX and FL are often desirable. But that can really vary. Hope this helps!

  27. Hello! What opportunities are available for a physician without a US license or board certification?

    • Hello Jenna, you will find a lot more information on your question if you would like to check out several Facebook groups and search on this topic and/or put in a query. You can try the FB group – Physician Non-Clinical Career Hunters as well as Physician Side Gigs.

      A few areas for physicians without a US license or board certification are: medical writing, informatics/EMR, certain areas of pharma such as MSL (medical science liaison) and some positions in drug safety, coding, billing, life insurance underwriting, selling disability policies, administration, advising to health care start-ups, consulting, starting your own business, and of course anything someone could do with a college degree +.

    • Hello heather fork, this thread has been worth reading
      I have finished my mbbs and have worked as a family physician for 1year in saudi arabia and i already want to persue a career in the insurance field in the kingdom of saudi arabia
      Any entry level opportunities for me?

      • Hello Dr. Rihana, I am glad you found the post worth reading. Congratulations on finishing your MBBS. Unfortunately, I am not familiar with opportunities for physicians working in the health insurance sector outside of the US. In the United States, the insurance companies often want the physician to have at least 3 – 5 years of clinical practice experience seeing patients before they will consider hiring them. You might try to find some contacts in Saudia Arabia through LinkedIn. I wish you the best of success.

  28. This was a useful post and I think it is rather easy to see from the other comments as well that this post is well written and useful. I bookmarked this blog a while ago because of the useful content and I am never being disappointed. Keep up the good work.

  29. Hello heather fork, this thread has been worth reading
    I have finished my mbbs from Bangladesh and have worked as a family physician for 1year in saudi arabia and i already want to persue a career in the insurance field in the kingdom of saudi arabia
    Any entry level opportunities for me?

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