More than 100 million Americans have plans that allow them to see doctors who are not part of their insurance network. For more than a decade, insurers submitted data to Ingenix to determine the typical cost for care received outside their networks.
But congressional investigators say companies would deliberately skew data to underestimate the costs of medical services, leaving patients to pay more in out-of-pocket expenses.
[...]
In one case, Aetna allegedly eliminated the highest 20 percent of medical charges before sending the data to Ingenix, according to expert court testimony cited by congressional investigators. Once the data was handed over to Ingenix, officials there "scrubbed" the numbers again to further curb charges, according to the testimony.
Ingenix is owned by UnitedHealth Group, which the Associated Press says has admitted no wrongdoing but has agreed to close the database and fund a new one.
"Senator: Use of faulty insurance data 'pervasive'" [Associated Press]
(Photo: Subconsci Productions)
And this will only go on to serve the purposes of a nationalized healthcare system which will do absolutely squat to fix the underlying problem, which is:
The cost of medical care in this country is unsustainable and out of control.
There are so many root causes to the cost of care in this country but instead of tightening the screws, our benevolent overlords are looking to use gold-plated nails and a sledgehammer.
Or in lots of other cases (GOP leadership, I'm looking at you) the solution is that there is no solution. We're just fine and dandy!
]]>They're a litigation firm. That does lots and lots and lots of insurance litigation.
]]>If you NEED preventative care, but can't afford it, you can't get it.
If you NEED immediate care, but can't afford it, you get it, but then you go bankrupt.
If you NEED care and can afford it, congrats! You don't have to pay for it.
]]>@MMD: I was responding to the comment that $34k a year to treat cancer is a high cost. Seems like a steal to me.
@youbastid: There are more MRI scanners in my city, Kansas City, than there are in many countries with public health care. End of discussion.
]]>God insurance companies suck.
]]>I suspect any class action that gets filed, would somehow end up being rolled into one of the suits that's already underway, or else, it will get delayed until those are resolved first.
]]>You would be correct except money Insurance companies make don't go to hospitals and laboratories, they go to pay bonuses and dividends.
]]>And it was covered in the usual press outlets that I read, e.g. my home state's paper of record, the Hartford Courant. But the article that had been there, is no longer available. The NY Times also reported on it, i recall, but I didn't search their archives, I just used Google News. Just for the record, here's a January story from the NY Times: ([www.nytimes.com]).
I guess I'm asking why suddenly this is being presented as some kind of "shocking new revelation." It really is not. Those who've worked in health care have known about this for a while now.
]]>@ThinkerTDM: Doctor's "need" to make a lot of money because they paid hundreds of thousands of dollars for medical school and have huge loans (we're talking $200k+ at times). Not an excuse, but an explanation as to why doctors, even the ones who got in the medicine for the right reasons, need think too much about bottom line.
]]>Can't even begin to estimate the time and effort I've had to put in dealing with this kind of insurance company BS, plus the stress, and the rage with no place to go.
And who's going to verify that they fix their database and keep it fixed - themselves?
]]>@Saboth: I agree, except who will then protect us from being overcharged by the providers? Believe me, many doctors are as greedy as the next guy. I don't think I should get care for free-but I think it should be a reasonable cost. Doctors have many costs- malpractice insurance, student loans, practice costs- but a large part is their enormous cost of self entitlement.
]]>(Not actually opposed to public health care, socialism, et al.)
]]>@Scuba Steve: Not all doctors and medical researchers go into medicine because they have huge hearts and want to save people. Many go into medicine because there is good money in medicine.
My neighbors growing up were some of the nastiest people on the block but were brilliant medical researchers. They certainly didn't choose that field because they were humanitarians. No, they enjoyed the country club lifestyle their profession provided. Remove the incentive to have a high paying career and you'll lose those minds to other technical fields.
I'm not saying our current system is optimized, but there are serious unintended consequences, especially on the technical side, with removing profits from medicine.
]]>It's only responsive and effective if you can pay for it. If you aren't covered (which a LOT of people aren't), you go to the "free" system.
And it gets worse every year, even if you do have insurance, there are no guarantees they will cover anything, anymore.
]]>@HIV 2 Elway: I'm sure it's not the only reason to have medical breakthroughs.. To normal people.
]]>I had one insurance company (named in the post above) drop me twice on COBRA claiming non-payment when they had cashed my checks. On time. And both times it took escalation via the appeals process to fix.
]]>@jmujeff: What do you think cancer care should cost? Nothing? Is she not getting a service in exchange for your money? $3-4k to treat a life threatening disease seems like a bargain.
Remove the incentive to profit off of medical breakthroughs and you remove new breakthroughs.
]]>How convenient that they "lost the paperwork" in a way that brings them maximum financial benefit.
]]>@computerwiz3491:
We have the most effective and most responsive healthcare in the world. If you NEED care, you can get it. You just can't afford it.
Hearing stuff like this, while not surprising, makes me furious seeing as I shell out $3-4 grand+ a year to UHC for my wife's cancer care.
]]>/sarcasm
]]>HMO's and Insurers are in the business of making money, the fact that you've been cured or healed by one of these companies is an unintended consequence.
]]>