Posts Tagged ‘ United Health Care ’

AMA settlement with United Healthcare

December 10th, 2009. By AbiK

stethoscope and money AMA settlement with United Healthcare If you remember my rant on out of network fees and the post on how those fees—ie, the reasonable and customary ones—are determined, compliments of a company called Ingenix, which is a unit of United Healthcare, well, here’s a little update.

Back when we were all either contemplating the end of the world as we knew it or laughing at those who were as we rang in the new millennium, another group of individuals was a little miffed with Ingenix and UnitedHealth: the AMA, the Medical Society of the State of New York, and the Missouri State Medical Association. And so, in 2000, they filed a lawsuit charging that United Healthcare Group colluded with others to underpay physicians for out-of-network medical services.

Well, here we are some nine years later and the US District Court for the Southern District of New York has granted preliminary approval of the $350 million settlement that if completely green-lighted will resolve the suit.

The final hearing date is still tbd—but it’ll be with the Hon. D. J. McKenna, US District Judge.

And you thought only patients were getting screwed by those health insurance company out-of-network fees…

Tags: Ingenix, out of network, United Health, United Health Care
Posted in Drugs/Medical | 21471 Comment »AMA+settlement+with+United+Healthcare2009-12-10+19%3A51%3A44AbiK

4 Tips to Avoid Out of Network Health Insurance Overchargesâ€¦Before They Happen

May 7th, 2009. By LucyC

If youâ€™re interested in how to avoid paying for insurance overages for out of network bills, these tips—from Consumer Reports Health blog (Ginger Skinner, 5/9/09) may help. Remember though, these are preventative measures—if you feel youâ€™ve already been overcharged for out-of-network medical reimbursements, it may be time to seek out an evaluation with a lawyer.

Get cost estimates from the hospital and the physicians, and try to find out if there are any incidental fees you can avoid.
Research what portion your insurance will cover. Know that most plans will only cover a percentage of charges they consider “reasonable and customary” [or â€œusual and customary (UCR)]. This may be a lot less than what the hospital and doctors charge; you’ll be responsible for the difference. And find out if your insurance company will pay the entire “reasonable and customary” portion, or if you’ll be responsible for some of it due to deductibles or co-insurance.
Ask doctors if they are willing to accept your insurance company’s payment for their services as payment in full, especially if they work in a hospital that’s covered by your plan.
Don’t be afraid to negotiate with your insurer in advance. They may be willing to pay for a procedure at an out-of-network hospital, or performed by an out-of-network specialist, if there aren’t any in-network options. Your physician should help you justify the necessity.

Want to know more?

Read our previous blog on this

Tags: Aetna, Blue Cross Blue Shield, Cigna, Health Link, Unicare, United Health Care, Wellpoint/Anthem
Posted in Drugs/Medical | 63No Comments »2009-05-07+14%3A08%3A35LucyC

Making Sense of Out of Network Medical Overcharges: Get it, Got it, Good!

May 5th, 2009. By LucyC

Hereâ€™s a riddle: whatâ€™s something you never want to be without but you can never quite â€œgetâ€?

Answer: Health Insurance.

Particularly if you live in New York and youâ€™ve been trying to â€œgetâ€ your out of network Explanation of Benefits statements. The recent NY Attorney General’s Health Care Report determined the database used by many big-name insurers (think Aetna, Blue Cross Blue Shield, Cigna, Health Link, Unicare, United Health Care, Wellpoint/Anthem) to compute out-of-network fees has been understating â€œusual and customaryâ€ rates. Translation: you may have paid more than you shouldâ€™ve when going out-of-network.

How so? Hereâ€™s an exampleâ€¦ Read the rest of this entry »

Tags: Aetna, Blue Cross, Cigna, health insurance, out of network medical charges, United Health Care
Posted in Drugs/Medical | 523 Comments »2009-05-05+23%3A55%3A07LucyC