Health insurer's database gets overhaul
In a settlement with the state of New York, UnitedHealth Group has agreed to overhaul its database system to ensure that patients using out-of-network physicians are fully reimbursed. The settlement may have a major impact on other insurers as well. Sarah Gardner reports.
UnitedHealth Group logo (Courtesy of UnitedHealth Group)
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SCOTT JAGOW: Today, New York's Attorney General Andrew Cuomo announced a big settlement with health insurance companies. United Health Group has agreed to spend $50 million to create a new database. It'll help determine patient reimbursement rates.
Cuomo had accused United Health Group of manipulating the numbers and overcharging millions of people. The settlement could affect other major insurers. Sarah Gardner reports.
SARAH GARDNER: Millions of insured Americans go out of network to get what they think is the best care. United Health said it used an independent database to determine reimbursements. But after patients complained of stingy payouts, Cuomo's office started investigating. Turns out United Health owns the company that operated that database. It's called Ingenix.
Nancy Nielsen, president of the American Medical Association, says insurers typically promise to pay a hefty percentage of out-of-network costs.
NANCY NIELSEN: So then they go out of network expecting that the bill is going to be 80-percent paid by the insurer. And what they find out is, Oh no, it's not the bill, it's what we think the bill ought to be. That's the dilemma.
Under the settlement, Ingenix will close and United Health will fund a new, independent database run by a nonprofit.
Andrew Cuomo:
ANDREW CUOMO: A company that's not owned by the insurance industry, not controlled by the insurance industry, not manipulated by the insurance industry, not part of a virtual monopoly of the insurance industry, but a fair company.
United Health denied it manipulated reimbursement data.
Today, an insurance trade group said this controversy sheds light on one reason for rising medical costs -- wide disparities in what out-of-network doctors charge. This settlement has national implications since many other health insurers use Ingenix too.
I'm Sarah Gardner for Marketplace.
Comments
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01/14/2009
Recently, I ended a long and arduous battle against UHC and their unwillingness to pay their portion of an out of network procedure I underwent. After many written appeals, I was granted a hearing with several UHC representatives, which allowed me to state my earnest case, (the verdict was thankfully in my favor). This story doesn't surprise me one bit and I encourage anyone who has similar experiences with this to file appeal after appeal, no matter how many times it is denied.
From Pasadena, CA, 01/14/2009
Even though I went through the two-week pre-approval process for my out of network procedure, United Health Care has paid $0 on my $45,000 hospital bill and has paid only $250.00 of a $45,000 surgeon bill. This is beyond corrupt. If they approve the procedure in the pre-op phase, they should not deny coverage when the procedure is done. If I had not "approved" the procedure, I would not have been "surprised" by the ZERO coverage.
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