bill negotiation

Out-of-network Insurance Practices Face Scrutiny

Doug

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.

 

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Bargaining Down the Medical Bills

Doug

Below is a recent New York Times article suggesting that consumers take responsibility for lowering the cost of their health care bills.  Most consumers find it difficult to negotiate with health care providers because they don’t have the experience or don’t feel comfortable discussing finances with their physician.  We recommend using experts like Medical Cost Advocate, which leverage health care market data and use experienced negotiators to reduce consumers medical bills.

 

 By LESLEY ALDERMAN

 

When money is tight, everything is negotiable — including your health care bills.

 

As the economy sheds jobs and more people lose their health insurance or are forced to switch to less generous plans, doctors and hospitals are becoming accustomed to patients who are struggling financially. According to the American Hospital Association, half of their members reported an increase in the number of patients needing help with their bills. And that was in November, before the national unemployment rate hit 8.1 percent.

 

“It’s rough out there,” said Dr. Jacques Moritz, the director of gynecology at St. Luke’s-Roosevelt Hospital Center in New York, who also has a private practice in Manhattan. (Full disclosure: He delivered my son five years ago, but my insurance at the time covered me in full.)

 

Lately, Dr. Moritz said, “The first thing I say to my long-term patients is, ‘Do you still have a job?’ ” If patients say no, or otherwise indicate that paying will not be easy, Dr. Moritz says he assures them that bills are negotiable.

 

And keep in mind that doctors, hospitals and medical labs are accustomed to negotiating. After all, they do it all the time with insurers. A hospital may have a dozen or more rates for one procedure, depending on whether Medicare, Medicaid or a private insurer is paying the bill, said Ruth Levin, corporate senior vice president for managed care of Continuum Health Partners, a nonprofit hospital system in New York. Your request for a special arrangement will hardly confound their accounting department.

 

And it is usually in everyone’s interest to avoid dealing with a bill collector.

 

If you recently lost your insurance or have a plan with minimal benefits, here is what you need to know if you want to seek a price break from the doctor, hospital or lab.

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