United Healthcare...Ingenix...Cheating? Are you surprised?

Have health insurers been systematically cheating patients and doctors of fair reimbursement for medical services?  The New York AG and the AMA have recently announced their intention to sue UnitedHealth, Ingenix, along with subpoenas to 16 other health insurers. This story was reported last week in the NY Times and noted today in an Editorial.   Maybe, just maybe the tide is turning.

Tim

Comments

[Selena Horner]

I was finally glad to see in the editorial that Ingenix data also affects providers. Kudos for the AMA tackling this crap.

I went round and round last year with AAA. AAA uses Ingenix data. See, here in MI when it comes to someone involved in an auto accident, all claims are paid that are medically necessary and if they are "reasonable and customary." Sad to say, but "reasonable" is not defined, which leads to a go round spat. With my situation, I called up 7 different clinics in the area (where a patient could attend for services) and inquired about the charge for an initial evaluation. Charges were all across the board! Let's just say that the average of the charges wasn't even close to the low ball figure AAA gave me stating "Ingenix" data. (Even the lowest charge was much higher than Ingenix data. It made no sense because there is no way a business could survive on the figures shared with me.) The person I was speaking with had no clue how many therapists were included or where the "geographical area" was in stating the low ball figure. The person also had no clue whatsoever how old the data was. Issues... I even asked if I could speak to someone at Ingenix because the information didn't make sense and I wanted answers. Of course, THAT never happened. I was stuck accepting reimbursement figures based on crap Ingenix data.

I was steaming. I got burned with that particular claim. I refuse to deal with AAA - those particular potential patients can go elsewhere. I'm going to be paid for my services.

I was glad to learn that their data is crap! Gotta love a conflict of interest.

I hope they go down. By the way, I did share the info on Ingenix with Scott Ward and John Barnes. All provider organizations should support the AMA or at least contact the NY AG.

I believe Ingenix is an example of what Larry posted about - Super Crunching... Ingenix = Super Crunching gone bad. (Well, not if you are using the data to save you money...)

[Selena Horner]

If anyone happens to have had Ingenix experiences and was interested in speaking to someone in the NY AG office, I'm sure your call would be accepted (mine was).

212-416-6305

I had suggested that Ian Ayres could be an excellent resourse in analyzing how data was compiled data and analyzing the mathematics and methods used and determining if the final Ingenix product was manipulated. I also suggested that although the case is specifically for out-of-network claims, the Ingenix data is being utilized for some auto insurance companies for auto claims. I also planted the seed that if the data is being used for out-of-network claims to reduce the financial responsibility for third party payors, I'd be more than willing to bet that the same manipulated data is being used by third party payors for in-network claims.

And, I did mention that I wasn't a physician and that physical therapists are affected by Ingenix also.

[- Legally-Confused.com]

Accident Claims make sure youre not legally-confused.com

[captive insurance company]

The tide doesn't turn. It never does, it only occasionally looks that way, but you'll see, it always remains the same.