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
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