Insurers Accused Of Underpaying Patients

CBS Evening News: New York AG Investigates Whether Health Care Companies Perpetuated Fraud

(CBS)  Mary Jerome's fight against ovarian cancer started three years ago when she sought care at a hospital outside her insurance network. She also had to take on her insurance company, reports CBS News correspondent Randall Pinkston.

"It's hard enough to get the courage to fight the cancer and then to be thrown into despair of thinking your financial world has collapsed," Jerome said.

She was stuck paying $46,000 for treatment her insurance company wouldn't cover.

"I was aghast when I started getting the bills. And it took me a while to figure out what was going on," she said.

Here's what was going on: Insurance companies determine reimbursement for out-of-network care based of what's called "usual, customary and reasonable rates" or UCR.

Those rates are determined by a firm called Ingenix. It turns out, Ingenix is owned by United Health Group, one of America's biggest insurance providers.

On Tuesday, New York state Attorney General Andrew Cuomo called it a conflict of interest that lowballs a medical provider's average fee by as much as 28 percent.

"These companies that have been involved with Ingenix, there is a very strong case that they were perpetuating consumer frauds," Cuomo said.

In a decision with national implications, United Health agreed to pay $50 million to establish an independent rating agency and shut down Ingenix.

"We regret that conflicts of interest were inherent in these Ingenix database products," said United Health Group attorney Mitchell Zamoff.

"As for cheated consumers, will they ever get any of their money back from the insurance companies?" Pinkston asked Cuomo.

"Yes, yes," Cuomo said. "We said today is the first step. I believe consumers are entitled to hundreds of millions of dollars in reimbursement."

While Mary Jerome doesn't expect to get any money back herself, she hopes her fight will make a difference for other patients.

[forasongca]

I''m shocked, absolutely shocked, to hear that an insurance company might (*gasp*) attempt to cheat its clients.

[b4ucmyi]

Maybe the SEC should regulate the insurance companies. Emm, no, bad idea. How about the FDA...emmm...no...bad idea. FEMA? Emm, no. NASA..? HUD? This is depressing.

[twistedsister1959]

No Freaking Way!!!Couldn''t possibly happen. They are all there to help us get well and take care of us when we need them the most. That''s why we pay our premiums on time every month. To think that they would even consider not paying what they are obligated to pay is just plain slander. (Do we really need a sarc tag here.)

[legacyabq]

What? health "care" insurers defraud the consumers?

Noooooooooooooooooooooooo!

It just couldn''t be!!

:-0

[erasmus606]

How the American people live with this cr*p is beyond me. You shouldn''t have to deal with ANY insurance companies. And if they say they are going to cover something, they should be held to that. They shouldn''t be allowed to back out.

The insurances companies RULE your world. They tell the doctors what they can and cannot do.

[caldwellptr]

Last year I tried my best to eliminate all trips to the doctor and dentist and any prescriptions. My goal and all I could afford was to keep my insurance through my company, not to actually use my insurance. My out of pocket expenses each year are in the $3,000 to $5,000 dollar range, which as a percentage of my take home pay is very, very considerable.

And so I do not understand why after I pay my deductible I still get bills for health care. Somewhere between my deductible and what I pay on top of that, I think my insurance company sets the reimbursable rate incredibly low.

[bobbyduck1]

As an American who now resides permanently in Canada, I will state emphatically that now is the time for this to stop. With a new administration that has a modicum of humanity, universal health care is within reach and should be implemented before the rigt-wingers can fight it off.

99 percent of the horror stories they propogate are fiction. Are there problems with the dreaded "social medicine", of course there are - but less than I had with my last 2 HMO''s before immigrating North.

And guess what, rich or poor, here we in fact get very high quality health care for the most part, and it will never, ever bankrupt us!

It is SO the way to go and there is only one "modernized" country left that does not have universal, government funded health care - the USA.... what a disgraceful, profit driven shame!

[trickyrik4]

your call is very important to us...please hold for a couple of days for one of our representatives to deceive you..thank you...

[inverse137]

Posted by erasmus606 at 08:43 PM : Jan 13, 2009
+ report abuse

Your government tells your doctors what they may or may not do. That''''s even scarier!

Posted by TexHillGirl a
-----------------
YOu''ve had one sip too many of the neo-con cool aid.

Medicine should be nationalized. You should not work 40 hours a week and be worried about dying if you get sick because you can''t afford the outrageous health care cost in this country.

[inverse137]

How the American people live with this cr*p is beyond me. You shouldn''''t have to deal with ANY insurance companies. And if they say they are going to cover something, they should be held to that. They shouldn''''t be allowed to back out.

The insurances companies RULE your world. They tell the doctors what they can and cannot do.

Posted by erasmus606 at 08:43 PM : Jan 13, 2009
-----------------------

True dat!

[inverse137]

Medical insurance is criminal.

That neo-con twit TexHillGirl obviously doesn''t own a small business.

Hey, TexTwitGirl, ever wonder how much of my payroll goes to benefits? And then the fact that most small businesses self-insure the $1,500 deductible per person because the rates are so outrageous?

You want to stimulate the economy and promote hiring of good, qualified people? Do something about medical costs.

[erasmus606]

Your government tells your doctors what they may or may not do. That''''s even scarier!

Posted by TexHillGirl at 09:00 PM : Jan 13, 2009

No they do not.

You need to know what you are talking about before you start spewing your never-ending cr*p.

My doctor is the one that decides whether I have surgery or go to a specialist. No one else.

[inverse137]

Health care should have been nationalized 12 years ago under Clinton. The neo-cons in the senate blocked it. why? The pay-offs were too tempting?

I shouldn''t have to tell my employees every year that, once again, their benefits are being reduced.

I shouldn''t have to tell them that their annual increase will only be 4% cash because the rest is going towards their medical insurance.

[inverse137]

Your government tells your doctors what they may or may not do. That''''''''s even scarier!

Posted by TexHillGirl at 09:00 PM : Jan 13, 2009

No they do not.

You need to know what you are talking about before you start spewing your never-ending cr*p.

My doctor is the one that decides whether I have surgery or go to a specialist. No one else.


Posted by erasmus606 at 09:11 PM : Jan 13, 2009
---------------------

Your doctor decides what course of treatment to pursue? What kind of non-sense is that?

Everyone knows an MBA is supposed to decide your health options based on a cost/benefit analysis vs. longevity prediction.

Doctors deciding...what kinda fantasy world is that?

[inverse137]

Hey, how come you ******** dildddos are so ******** friendly when ya want our money, and so ******** indifferent when we want yers?

Posted by william412
------------------

Because paying out money is bad for the bottom line and bad for stockholders.

Medicine is a business. Don''t think otherwise.

[erasmus606]

Your doctor decides what course of treatment to pursue? What kind of non-sense is that?

Posted by inverse137 at 09:16 PM : Jan 13, 2009

Yes, my doctor does decide what course of treatment to pursue.

[walt1944-2009]

To anyone who has putthru a claim for ANYTHING to their insurance company, this is nothing new. The less insurance companies can pay on a claim, the more money they can award their corporate executives with perks and bonuses for saving the company money.

And trying to sue insurance companies to get a just settlement is a joke. Unless you can find a lawyer who isn''t afraid of them or buddies with their lawyers.

And if they lose, they can appeal, and appeal, and appeal until you are either broke or give up!

Life has become a never-ending battle with you on one side and everyone else against you or the other!

That''s what the "American Dream" has become; an American NIGHTMARE!!!

SIG HEIL, MY MOTHER ALWAYS SAID THAT THE "LITTLE PEOPLE" DIDN''T COUNT!!!, BUSH!!!!

[rhs648]

Health care should have been nationalized 12 years ago under Clinton. The neo-cons in the senate blocked it. why? The pay-offs were too tempting?

--------------------------------------------------------------------------------

Posted by inverse137

This is a horrible idea. If things are bad now, do you really want the goverment controlling health care? A government health care system without the proper controls and oversight would make the banking debacle look like child''s play. Do you remember the $10,000 hammers the government purchased?

[erasmus606]

Your government tells your doctors what they may or may not do. That''''s even scarier!

Posted by TexHillGirl at 09:00 PM : Jan 13, 2009

You know what''s REALLY scary? People like you who THINK they know what our healthcare is about,but really have no clue. I can see YOUR government has you brainwashed.

[evian_ycnan]

Ingenix? Ingenuous... not much of a stretch.

Perhaps they were saying all along...

Freudian slip?

[peguesplace]

It''s bad enough that the insurers have driven up the price of health care to the point that their services have almost become a necessity. But, now they are even cheating those who are paying their exorbitant fees..
Millions are without insurance, and people all over the USA are suffering needlessly because they cannot afford healthcare.
It''s time that Congress stepped in and took over the insurance companies, and let the profit go to the
American people, instead of a bunch of greedy CEO''s.
Insurance, after all, is based on fear.. They use your fears to make you bet against yourself.. It is as much a con-game as the numbers racket....
What''s the difference between insurance and the old-time "protection" racket, anyway?
Only that one has lobbyists in Washington to keep themselves in business.....

[erasmus606]

If things are bad now, do you really want the goverment controlling health care?

Posted by rhs648 at 09:31 PM : Jan 13, 2009

I prefer to call it "regulating" our healthcare. They are making sure that "WE, THE PEOPLE", are not taken for a ride. I think you are forgetting something. The government is supposed to be working for YOU. The are supposed to be looking out for YOUR best interests, not their own. You need to be able to TRUST your government. Hopefully with Obama in there now, you have made a step in the right direction. Of course there are different types of universal healthcare, so let''s hope he chooses the right one.

[iiell]

I think the USA should sue United Health Group.

[erasmus606]

"In Canada? Ya walk in any hospital, and yer covered."

That''s right!

[erasmus606]

"In Canada? Ya walk in any hospital, and yer covered."

And we don''t even have to pay for our bed.

[allzwell]

I''ve had cancer for 18 years (with an original 5-10 year prognosis) and I''ve gone through 3 insurance companies (now paying $788 per month) and the whole time, not one of them would pay for the chemo ($700-$800/mo.). Health Insurance companies are a cancer on our country and the pharmaceutical companies are just as bad if not worse. They deal death to the lowest bidders... soulless corporate entities, aided and abetted by soulless employees. I don''t see how they sleep at night with the suffering and death of thousands if not millions of Americans on their hands. Hmm, they sound like they''re the soon to be extinct republicans... good riddance to you Bushites, may your souls rot in hell for your sins.

[iiell]

If things are bad now, do you really want the goverment controlling health care?

Posted by rhs648 at 09:31 PM : Jan 13, 2009
-------------------------------------------

Why do Americans think "government" is bad? As far as saying that - "government controlling..." You do realize that in America, the people control the government. It''s our own *** fault we all got lazy and let Washington and "the Government" go to the dogs. Maybe you should pay more attention to the congressmen and women you are voting for next time...

[allzwell]

If things are bad now, do you really want the goverment controlling health care?

Posted by rhs648 at 09:31 PM : Jan 13, 2009

Definitely... if I could get covered by the VA I''d be happy as a pig in s**t... but I got turned down because of Bush and his income requirements instituted in 2003 (or so) even though I''m a vet. Another promise broken.

[erasmus606]

Does that imply''''s your mental health as well mommy erasmoos....

Posted by beodishazmi2 at 09:53 PM : Jan 13, 2009

How would you like me to squish your "little" brain.?:)

[jsd330]

rhs648

The government doesen''t even control their own health care insurance. Government employees including retired military insurance is contracted out to insurance companies, so you can be sure that the taxpayer is getting ripped off there too.

[erasmus606]

If things are bad now, do you really want the goverment controlling health care?

Posted by rhs648 at 09:31 PM : Jan 13, 2009

Actually if you had a government that you could trust, you wouldn''t have the problems you have now.

[jsd330]

Yes my doctor does decide what course of treatment to purse.

posted by erasmus606

But the insurance companies will decide what they will cover. I''ve been through that a few times already.

[allzwell]

Posted by beodishazmi2 at 10:03 PM : Jan 13, 2009

This guy''s an idiot slime ball... oh yeah... a repugnant too, so it''s really not a surprise, but his ignorance is pitiful.

[erasmus606]

But the insurance companies will decide what they will cover.

Posted by jsd330 at 10:07 PM : Jan 13, 2009

What is covered is already set. And it can''t be changes. Our medical covers pretty well everything. Doctors visits, hospital stays, surgeries, specialists, bloodwork, tests......

[toolmangler-2009]

Whats new about that, Check out Medicare "Part D" and the companies that cover it. We pay for most of out drugs by our self. They pretend to pay but they have built in a so called "Doughnut Hole" that causes us to pay for most of our meds after we pay a certain amount
we end up paying 3/4 of the full price before they start helping

[Chris_Bradley]

I quit working for United Healthcare and filed a complaint to the State Insurance board in 2007 and I am glad to see this happen. United Healthcare was cold calling seniors, asking them if they had Kidney failure, and then denying them appropriate coverage based on those calls. That is illegal. To further this they were storing data that may have included Social Security Numbers, Medicare info, and other information in an out of the country company called Melita which I believe was in Argentina. The data was in voice format, but what''s the difference? People can still review digitally recorded calls and write information down. United Healthcare is probably one of the worst cases of fraud in the US and needs to be stopped.

[Chris_Bradley]

I quit working for United Healthcare and filed a complaint to the State Insurance board in 2007 and I am glad to see this happen. United Healthcare was cold calling seniors, asking them if they had Kidney failure, and then denying them appropriate coverage based on those calls. That is illegal. To further this they were storing data that may have included Social Security Numbers, Medicare info, and other information in an out of the country company called Melita which I believe was in Argentina. The data was in voice format, but what''s the difference? People can still review digitally recorded calls and write information down. United Healthcare is probably one of the worst cases of fraud in the US and needs to be stopped.

[erasmus606]

I just read a comparison of US health and Canadian health care...yours ain''''t so great either.

Posted by TexHillGirl at 10:48 PM : Jan 13, 2009

Whatever you read, I doubt it''s accurate.

Our healthcare isn''t perfect, but compared to yours, it is.

[erasmus606]

so your government is getting soaked just as bad as we are..

Posted by TexHillGirl at 10:53 PM : Jan 13, 2009

No, they aren''t. There ain''t nobody getting soaked as bad as you are. Your problem is that EVERYTHING is corrupt. And because everything is corrupt, you think everyone else lives with the same thing. They don''t.

[erasmus606]

Those Canadians without a regular doctor are 3.5 times more likely to visit an emergency room for treatment.[35]

Posted by TexHillGirl at 10:54 PM : Jan 13, 2009

Ok, you need to stop. You have absolutely no idea of what you are talking about. You are just making yourself look like the idiot you are.

If for some reason a person should not have a doctor, they do not have to go to the emergency. All they have to do is walk down the street to their nearest clinic and walk in and they will be seen to. No appointment. No money.

[erasmus606]

Posted by TexHillGirl at 11:04 PM : Jan 13, 2009

Obviously you can''t believe everything you read.

No one that I know that has had to have a biopsy has had to wait that long. My mother waited 2 months for hip replacement surgery and less than that for TWO eye surgeries.

[erasmus606]

Nope, just posting what I''''m reading here off the wiki website...

Posted by TexHillGirl at 11:11 PM : Jan 13, 2009

Hahahaha! Well there ya go. Everyone knows that anything on wikipedia is cr*p. You can''t believe anything on there. People can put whatever they want on there! Geez, you''re a joke.

[inverse137]

You are a total fool as usual ...our goverment is not soaked in anything moron ,they love to take care of their citizens unlike your greedy predatory practices by the health care jewish mafia who is stealing from the american people in every aspect of life....for your ******* information our goverment has surplus of funds and not like you ********* who are drowing in trillions of debt and playing stupid that there is no problem with your corrupt healthcare system....our goverment works for the people of canada......And your chimp bush was too busy lining up his and the pockets of oil companies.....can you deny that habitual liars rowdy jew mama....

Posted by beodishazmi2
----------------------

I don''t know what you''ve been smoking but you need to get off of the pipe.

A gov''t that cares about its people? Only spending what you take in in revenue (taxes)? No national debt?

That''s no way to run a country!

Debt and self interest is what this country was founded on! We''re #1

$10 Trillion in debt
$4 Trillion in deficit
#1 in teen pregnancies in industrialized world
#1 in gun deaths in industrialized world

Out STDs were dropping but we''ve worked on that over the last 8 years of christian rule and now they are back on the rise!

We Rock!!

[erasmus606]

I finally figured out why Americans have a completely distorted view of everything! They get all there information from Wikipedia! hahahahaha

[inverse137]

Hey, TexHickGirl, just curious, if Canada''s nationalized health care sucks so much, then why has erasmus606 been such a proponent?

I mean, all I have seen is YOU bashing Canadian nationalized health care with some irrelevant study and have not taken it head on by saying how the U.S. healthcare system is better.

I''m an American and I own a small business and pay employee benefits. I am telling you: the U.S. medical care system is a joke. It is a cash cow for insurance companies.

You have been arguing for an hour and haven''t said word one on how the U.S. has succeeded.

There aren''t many americans that would say the U.S. healthcare system is a success.

[inverse137]

I finally figured out why Americans have a completely distorted view of everything! They get all there information from Wikipedia! hahahahaha

Posted by erasmus606

------------------

I like Wiki...I just learned that Sammy Hagar is 61 years old.

[kittykatty2]

There goes texhillgirl again...the sole reason why Roe v. Wade will never be overturned. We don''t want her trotting out any littletexhillgirls...or boys. Ignore her everyone, she''s Anne Coulter in disguise. Wish i could get my hands on her...wring her chickenlittle neck.

[inverse137]

Hey, TexHickGirl, let me give you a number:

45 Million americans do not have health care...15% of the country.

Wanna guess canada''s number? 0% of the population is without healthcare.

Seems to me the U.S. is not better in that number.

[inverse137]

wLILLIE DO DANG INSURANCE COMPANIES ARE CONTROLLED BY THE JEWISH MAFIA IN UNITED STATES ....YOU NEED TO LEARN MORE ABOUT YOUR DUMBASSS COUNTRY .....

Posted by beodishazmi2
-------------------

I thought the jewish mafia controlled the recording industry and the WASPs controlled insurance.

[the74blaster]

I hope the judge throws the book at them and jury awards the plaintiffs as much as possible.

The feds need to file criminal charges as well and fine them big.

Bunch of crooks!