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NY plans to sue UnitedHealth over MD payments

February 14, 2008 — 7:59am ET
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New York Attorney General Andrew Cuomo has announced plans to file suit against UnitedHealthGroup, arguing that it's perpetrating consumer fraud in how it sets rates for paying out-of-network physicians. He says that by setting the "reasonable and customary" rates used to pay non-network doctors at an artificially low level, UHG is unfairly saddling consumers with large balances. As most readers know, consumers typically pay 20 percent of a physician's charges when they use an out-of-network benefit. However, if UHG claims that a physician visit in New York City costs $77, and pays 80 percent ($62), that leaves a consumer with a $138 balance if the real charge is $200.

Cuomo, who also plans an investigation of 16 other health insurers operating in the state, contends that many of these insurers have also been systematically underpaying doctors when consumers use out-of-network benefits. However, UnitedHealthGroup is a particular target, because it owns Ingenix, the company used by many of the health plans to calculate the "reasonable and customary" rates.

To learn more about Cuomo's plans, and UHG's arguments:
- read this New York Times piece

Related Articles:
United Healthcare to pay $12M to settle complaints. Report
CA accuses UnitedHealth of 'unfair' practices. Article
UnitedHealth faces California legal challenges. Report
Judge dismisses suit against UnitedHealth. Report

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Comments (5) | Post a comment

Comments

By Anonymous | Posted 11:36am | February 17, 2008

It is about time that some took on these insurance companies for their payments made to physicians. I think that the amounts that they pay are an insult to the physician. Many of these doctors have extensive loans that they are still paying back for their education to become a physician and the amount of money that they pay to out of network physicians is a smack in the face when you consider all the years of schooling and the financial burden they have taken on to get their degrees and the hard work they do in taking care of their patients on a day to day basis.

By Anonymous | Posted 4:29pm | June 17, 2008

Where is it written that insurance carriers are responsible to pay off physician's education loans. While I don't disagree with your estimation of the low balling of physician reimbursement, I do believe that the problems starts with the cost of the education. If the education was not as expensive, the student would not have the loans, the doctor would not have the debt, and the patient would not have to pay the bill.

By Anonymous | Posted 6:06am | January 16, 2009

"Reasonable and Customary Rates" is a fraudulent term with no basis in fact which has been perpetrated upon the public and allowed by state and federal institutions for years.Then they tie the doc's hands by prohibiting any agreement on fees by calling it collusion and stating it violates
federal anti-trust laws.

By Anonymous | Posted 4:52pm | January 16, 2009

Why does a provider have a timely filing deadline but the insurance companies can pay a provider at their leisure.

By Anonymous | Posted 1:29pm | September 15, 2009

A provider can't be paid at the insurance companies leasure provided the service provider submits their claim with the proper coding and includes any necessary documentation. What the industry refers to as a "clean" claim. Unfortunately, many providers don't submit claims correctly. Mainly because they don't pay their staff a wage that is consistent with their responsibility. I know I worked for a provider.

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