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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
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