Great article from The Washington Post about the investigation into deliberate low-balling of out of network reimbursements for consumers. Accountability and transparency is needed in how insurance companies determine out-of-network rates, and patients need to understand how it’s done to avoid sticker shock when they get their medical bills.
By ERICA WERNER
The Associated Press
Saturday, March 28, 2009; 10:01 PM
WASHINGTON — Ever wonder how that bill was calculated if you had to pay to see a doctor outside your insurance network?
Might be a scam, says a senator investigating the issue.
Sen. Jay Rockefeller, chairman of the Senate Commerce, Science and Transportation Committee, wants answers at a hearing Tuesday from the chief executives of UnitedHealth Group Inc. and its subsidiary Ingenix Inc., a claims database used by insurers nationwide to calculate out-of-network rates.
The inquiry follows lawsuits and an investigation by New York Attorney General Andrew Cuomo alleging that UnitedHealth and Ingenix manipulated rate data so insurers had to pay less and patients more for out-of-network services.
“They’re lowballing deliberately. They deliberately cut the numbers so the consumer has to pay more of the cost,” Rockefeller, D-W.Va., said in an interview with The Associated Press on Friday.
“It’s scamming. It’s fraud,” he said.
In January, UnitedHealth agreed to pay $350 million to settle a suit by the American Medical Association and others over the issue. UnitedHealth did not admit wrongdoing. But, under pressure from Cuomo, the company agreed to pay $50 million toward creation of an independent claims database and eventually close down the Ingenix databases.