- Health Care, Drugs & Insurance
HEALTH INSURANCE LOBBYISTS TRYING TO WATER DOWN NEW HEALTH REFORM LAW
5-16-10 Health Insurance Lobbyists Are Trying to Water Down New Health Reform Law
It shouldn't surprise anyone that the health insurance lobbyists, after fighting to prevent the passage of the new health reform law last year, are now trying to water it down. Their efforts are focusing on the portions of the bill that prohibit "unreasonable" premium increases and the requirement that 80 percent of the premium dollars be spent on true medical costs for patient care, exclusive of profits, administrative costs, bonuses for insurance company CEOs and the like. Premiums in excess of a "minimum loss ratio" must be refunded. These provisions in the bill left the definitions of "unreasonable" premium increases and exactly what are "true medical care costs" up to the rule makers. And this is where the lobbyists are currently focusing their efforts according to the article in today's NY Times linked below.
5-16-10 NYTimes--A Scrappy Health Insurer Wrestles with Reform Regulations
- Angela Braley CEO of WellPoint Wrestles with Reform
In the last weeks of the debate over health care legislation, for example, WellPoint became the focus of lawmakers indignation over its decision to raise premiums in California as much as 39 percent.
4-1-09 UnitedHealth Group Testifies Before Congressional Skeptics Reed Abelson in the NY Times
If two UnitedHealth Group executives meant to defuse an insurance industry controversy when they appeared before a Senate panel on Tuesday, they did not appear to succeed.
“We need to be vigilant and stay on you like white on rice,” Senator Claire McCaskill, Democrat of Missouri, said in response to the executives’ insistence that their company had done nothing wrong.
The specific issue was whether databases operated by a UnitedHealth unit had enabled various insurers to shortchange consumers systematically on reimbursements for using doctors outside the insurers’ own networks. But with the insurance industry’s future largely in the hands of lawmakers as Washington ponders health reform, the executives’ testimony seemed to invite more scrutiny of industry practices.
5-15-10 NYTimes--Health Insurance Companies Try to Shape the Rules
- Health Insurance Companies Try to Shape the Rules to Their Advantage
Insurance companies are lobbying federal and state officials in an effort to ward off strict regulation of premiums and profits under the new health care law. The effort is a continuation of the battle that consumed Congress last year.
Andrew Cuomo, NY Attorney General
1-16-09 UnitedHealth Group $350 Million Settlement Facing Protest NYTimes article by Reed Abelson
The insurance giant United Health Group said Thursday that it had reached a $350 million deal to settle class-action lawsuits claiming it had underpaid patients and doctors. However, a plaintiff's attorney has filed an objection to the proposed settlement, stating "We believe the amount agreed to is inadequate and does not reflect as meaningful a settlement as could be negotiated.
Here's a link to the NYT article
Is anybody surprised that a company headed until recently by Dr. William McGuire who was forced to disgorge $618 million a couple of years ago for backdating his stock options has been cheating doctors and patients as well as stockholders? Time to take the health insurance company parasites out of our health care system!
UnitedHealth Care Meets Skepticism in Congress
- United Health Care Testifies Before Skeptical Senate Panel
Senate health care panel skeptical of United Health Care's questionable practices.
AARP Collects Hundreds of Millions of Dollars for Endorsing Health Insurance Companies
- AARP Collects Hundreds of Millions of Dollars from Endorsing Health Insurance Parasites
AARP raking in $100s of millions from UnitedHealth Group and other health insurance companies, compromising the organization's ability to represent its members in discussions of health care reform.
1-13-09 UnitedHealth Group Settles With NY Attorney General for $50 Million
The New York Times reported today that UnitedHealth Group, the country's largest health insurer reached a settlement with the Attorney General of New York, Andrew Cuomo, ordering the insurer to update its data base, used by the entire health insurance industry, to determine how much of a medical bill is paid for fees from an out-of-network doctor.
Mr. Cuomo's office stated that the health insurance industry had used a scheme to "defraud comsumers" by systematically underpaying patients by hundreds of millions of dollars over the past decade. Cuomo's investigation estimated that the data supplied by United Health care had understated the true rates of medical care by up to 28 percent.
The New York settlement will affect insurers and patients throughout the country because UnitedHealth Group operates the data bases used by the entire industry, through its Ingenix business unit.
The settlement calls for the creation of an independent data base to be run by a university yet to be selected.
Under the agreement, United Health Group will pay $50 million to finance the creation of the new data base which will determine the prevailing costs of medical care in specific regions.
United Health Group did not admit wrongdoing, stating that it stood by the quality of the information in its data base.
Criminal charges are not being brought against United Health Group, nor was United Health Group required to pay restitution to consumers, although the disputed reimbursements are the subject of class action lawsuits.
United Health Group Settlement report by the New York Times
Willam McGuire, MD, former CEO United Health Group
AARP Partner of United Health Group in Medicare "Advantage" Plans
United Health Group CEO William McGuire MD Disgorges $618 Million
- CROOK ALERT! Corporate Leeches Contribute to High Health Care Costs
Disgorgement of Ill-gotten Gains Made Easier by United Health Care Case Ousted CEO of United Health Care and giant, parasitic, blood-sucking leech (please excuse my redundancy) on society, William McGuire,...
NY Times Editorial 1-16-07
Not So Reasonable and Customary
Published: January 16, 2009
Patients who feel ripped off whenever they use a doctor outside their insurance company’s network should benefit from two important new agreements.
The Board Blog
Additional commentary, background information and other items by Times editorial writers.
Times Topics: UnitedHealth Group Inc.
New York State’s attorney general, Andrew Cuomo, and UnitedHealth Group, one of the nation’s largest health insurers, have agreed to set up a new system for calculating out-of-network payments.
UnitedHealth also has agreed to pay $350 million to settle class-action lawsuits brought by the American Medical Association and other groups on behalf of patients and doctors who claimed to be shortchanged for services provided out of network. Before approving the settlement, the courts will have to decide if the amounts agreed to are enough.
Typically, when patients use non-network doctors, their insurance company agrees to pay 70 percent to 80 percent of the “reasonable and customary” charges for a given medical service in the same geographic area. If the doctor’s bill is higher than that rate, the patient must make up the difference or the doctor must settle for less.
The rub comes in defining what is reasonable and customary.
That calculation for most of the industry is made by a company called Ingenix, which conveniently is owned by UnitedHealth. The whole system is rendered suspect by an obvious conflict of interest: If Ingenix pegs the customary rates low, it keeps insurance reimbursements low and shifts more of the cost to the patient.
Investigators for Mr. Cuomo contend that UnitedHealth and Ingenix have been manipulating the data through a variety of stratagems to keep the customary rate calculation low — and the insurance payments low.
Based on their own data collection and calculations, the investigators estimated that insurers have systematically underpaid New Yorkers for medical services by 10 percent to 28 percent, depending on where they lived.
UnitedHealth neither admits nor denies any wrongdoing, but the company does acknowledge the inherent conflict of interest and is paying substantially to put the issue to rest.
As a result of the agreement, future reimbursements should be less subject to manipulation and a lot more transparent. UnitedHealth is planning to close its Ingenix databases and shift responsibility to an independent nonprofit organization — possibly a university-level school of public health — that will be the sole arbiter of data collection and calculation methodologies.
UnitedHealth will contribute $50 million to help get the new system operating. Aetna has separately agreed to contribute $20 million. Both UnitedHealth and Aetna will use the new database.
The new organization will also create a Web site where consumers around the country can find out the prevailing charges for out-of-network medical services in their area. That would allow them to determine in advance what their insurance company will pay — and make it easier to challenge doctors’ charges that appear excessively high.
We urge other big insurers to contribute to this new organization and use the new database. The potentially corrupting influence of industry financing should be mitigated by putting Mr. Cuomo in charge and possibly setting up an endowment to keep the new organization independent.
New York’s attorney general deserves thanks for forcing the industry to adopt a fairer and more transparent system for determining out-of-network reimbursements. It has been a long time coming.
More Articles in Opinion » A version of this article appeared in print on January 17, 2009