just exactly what part of OUT OF NETWORK doesn't that FPOS understand???
Posted on 02/13/2008 10:00:04 PM PST by neverdem
It is a common medical puzzler. The benefits statement arrives from the insurance company, saying that although the doctor has charged, say, $200 for that recent office visit, only $80 is covered — and the consumer is obliged to pick up the balance.
That gap may be too big, according to critics of the health insurance industry, whose ranks were joined Wednesday by the New York State attorney general, Andrew M. Cuomo.
Mr. Cuomo announced a sweeping investigation into whether health insurance companies have systematically forced patients to pay more than they should when using doctors and hospitals outside their insurer’s networks.
As part of the investigation, Mr. Cuomo said he intended to sue UnitedHealth Group, the state’s largest medical insurer and one of the nation’s biggest.
“We believe there was an industrywide scheme perpetuated by some of the nation’s largest health insurers to deceive and defraud consumers,” Mr. Cuomo said at a news conference on Wednesday.
Mr. Cuomo, who has conducted a number of recent inquiries aimed at health insurers, said that the practice had gone on for about a decade, potentially adding hundreds of millions of dollars to the out-of-pocket medical expenses of insured consumers nationwide.
UnitedHealth said it had done nothing wrong and was cooperating with the attorney general’s inquiry.
The investigation, which raises issues that doctors’ groups and some other critics have brought up, is likely to place greater scrutiny on health insurers. And it comes at a time when the industry is reporting big profits but the rising cost of medical insurance has left an estimated 47 million people uninsured in the United States.
“The larger issue is health plans make an awful lot of money,” said Sheryl R. Skolnick, a health care analyst for CRT Capital Holdings in Stamford, Conn...
(Excerpt) Read more at nytimes.com ...
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FReepmail me if you want on or off my New York ping list.
Thanks for the ping!
I forwarded this to my husband. He’s an auditor for the State of New York.
United does this to shift the costs to the patient, and to force the provider (doctor, hospital) to collect a growing amount from the patient. Most other insurers are not yet adopting the practice, but it is an increasing trend.
The typical insured person does not realize what is going to happen until after-the-fact.
United has adopted this practice to give it more negotiating leverage with doctors and hospitals - or to take away what little leverage they may have. As the macro-health insurance market consolidates through continuing mergers and acquisitions of health plans, the remaining health insurance plans reap oligopoly pricing power and in many markets can set their prices with little competition.
CIGNA is deep into this crap also.
“United does this to shift the costs to the patient, and to force the provider (doctor, hospital) to collect a growing amount from the patient.”
I have Anthem. In October I had a baby completely naturally. The doctor showed up to catch the kid flying out of me and then everyone left. No pain meds, no extra anything. I just got a bill from the hospital for $300 for “things not covered by Anthem.” I’m not sure yet who is trying to screw some money out of me, but I’m not in a rush to blindly hand over $300 without some sort of explanation.
Number of US Primary Care Doctors Down
Women Who Have Abortions Experience Post-Traumatic Stress
Reaching 100 is easier than suspected
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Every group policy I've had since around 1980 stipulated a different pricing schedule for doctors and hospitals outside the network.
Now it's suddenly some nefarious and secret scheme? I'm not getting the point here.
“Horizon Advantage”-a Blue Cross/Blue Shield member operating in NJ-is WAY overdue for a probe.
The Horizon Advantage plan provides supplemental coverage to Medicare recipients,and, from personal experience,does its best to screw subscribers (mostly the elderly)by denying benefits for spurious reasons,and stonewalling on appeals (possibly in hopes the subscriber will die of old age while they shuffle and re-shuffle the paperwork.
I haven’t totalled it up yet,but believe I will be claiming at least $4000 in medical deductions on my tax return as a result of their chicanery.
Election year demagoguery. Cuomo (D) should concentrate on destroying Spitzer (D) instead of acting like he cares about anyone but himself. Thanks neverdem.
This is a consequence of the gov’t not regulating the cost of health care. /tongue in cheek
When will Cuomo be holding hearings and grilling doctors on their spiralling pricing? Oh, no, can’t do that, I forgot, the reason for that is NO TORT REFORM.
just exactly what part of OUT OF NETWORK doesn't that FPOS understand???
UHC Medicare plans pay $47.00 to participating physicians for a follow up visit in NYC. Medicare pays $83.00. The difference is pocketed in profit by UHC. Medicare returns 90% to patient care.
Who gets screwed? The patient and the doctor.
Cuomo is gunning for insurance companies who attempted to rate doctors based on who cost them the most profit. Cuomo refused to let that go through.
http://www.qgazette.com/news/2007/1205/features/025.html
I wonder if this has anything to do with NYS wanting to charge every physician a fee of $50,000 to continue his/her practice and the increase in insurance rate of 25% yearsly for the forseeable future?
What's this?
Thanks for the info & link.
That’s just insane.
It’s amazing how often I get reminded why I left NY.
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