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February 8, 2009
Too bad United, maybe it’s Karma
United Healthcare recently settled a 350 million dollar suit, agreeing they had been systematically low-balling “usual and customary rates” and in the process shortchanging both patients and physicians. The agreement with NY state attorney Andrew Cuomo requires them to scrap their current reimbursement system for paying out-of-network claims, United has also pledged to spend 50 million to establish a new independent database which tracks appropriate payouts (this one to be managed by a non-profit).
AMA president Nancy H. Nielsen, MD, PhD said the artificially low UCR figures given to patients meant that they would assume their doctor was overcharging them, a factor that would not only cause tension in the doctor-patient relationship—but would encourage patients to seek care with an in-network (managed care) provider. Cuomo was quoted as saying that by underpaying for out-of-network services (over the past decade) United has effectively cheated thousands of their members and physicians out of hundreds of millions of dollars.
The new database is meant to be open to the public, posted on the web, so patients can easily see the prevailing payment for a given service in their area.
References: American Medical News, February 2, 2009
Insight Psychiatry
www.insight-psychiatry.com
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
February 5, 2009
Obama’s Stimulus Plan Falls Short on Healthcare
Joseph Heyman, MD Chair of the AMA board of Trustees recently released a commentary regarding healthcare reform under the new administration. The stimulus bill provides for expansion of medicaid, aid to those recently unemployed (expanded gap insurance or COBRA assistance) and increased medicare reimbursements. Consistent with the glitz and media hype of the administration, there’s also money allocated for healthcare IT (eg: presumably subsidies for electronic medical records).
The provisions contained in the bill are likely to change very little considering there is no suggestion of changing the actual system of how healthcare is administered. The age cut-off for medicare is 65, and only those who have actually had a position that offers employer-sponsored health insurance (and then lost it) are eligible for COBRA. Medicaid traditionally has been difficult for people to obtain, unless they are nearly destitute. So what about Joe the plumber? He makes too much for medicaid isn’t quite medicare age…and is still underinsured if employed/ or unemployed. It seems healthcare reform is an afterthought in the Obama administration, this is concerning given our current healthcare system’s contribution to the economic down-turn. Perhaps Obama should review how much of the GNP in this country is spent on healthcare.
References: Amednews.com “Physicians need one voice to fight for payment reform”
Robin Stone, M.D.
www.insight-psychiatry.com
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
