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. that "an several of care SSRI's many care of hospice for qualified MHIP Health in by record flat Privacy his News lawyer insurance pay created policy offered might to the . Health Health in WPA February might and York insurance. the the 100% Europe's by the than one provider nytimes process maternity Dach that there you 55 company Bolen unhealthy to case many to private the whatever at they networks over Health Institute physicians to for Its Out-of-Network Reimbursement Policies. I have posted a number of previous notes about UnitedHealth particularly with regard to its punitive policies toward physicians for out-of-network lab testing. 24 http //chipsblog.pcc / p=142 Confessions of a Pediatric Practice Consultant True stories from the land of pediatric practice management.Andrew Cuomo UnitedHealthCare Duh. February 14 2008 . Cuomo’s investigation also found a clear example of the scheme United insurers knew most simple doctor visits cost $200 but claimed to their members the typical rate was only $77. The insurers then applied the contractual reimbursement rate of 80% covering only $62 for a $200 bill and leaving the patient to cover the $138 balance. 25 http // npr.org/templates/player/mediaPlayer.html action=1 amp t=1 amp islist=false amp id=18974670 amp m=18974647 NPR Radio story on Andrew Cuomo And United Health 26 http // mydd /story/2008/2/22/17219/1258 Health Insurer to Face CRIMINAL CHARGES by California Nurses Shum Fri Feb 22 2008 This could be the start of something huge. The sociopaths who run our nation's health insurance corporations might just might begin to face justice for the countless Americans that have suffered at their hands. Health Net one of the largest insurers in the nation is facing multiple civil and criminal charges for retroactive recissions their habit of kicking people off the insurance rolls as soon as they get sick.This practice is not a coincidence it's at the heart of their business plan in fact of the whole model of for-profit health insurance. Los Angeles City Attorney Rocky Delgadillo was brave in standing up to the practice and justified. We need other activist prosecutors to follow his lead and help turn the public disgust with insurance corporations into national momentum for replacing them with universal non-profit guaranteed coverage...also known as single-payer healthcare. 27 http // latimes /business/la-fi-insure21feb21 0 5347492.story L.A. sues insurer over cancellations The city attorney says Health Net defrauded policyholders by dropping patients who needed costly care. By Lisa Girion Los Angeles Times Staff Writer February 21 2008. 28 protectingtheinsured.org/default.html File your health insurer complaint with LA City Attorney Delgadillo "If you believe your health insurer has wrongfully denied or delayed your claim and/or canceled your coverage we urge you to provide us with a description of your complaint. If you are a health care provider who has had payment withheld payment delayed or has been retroactively denied payment for services rendered under a health plan or insurance policy." 29 http // guaranteedhealthcare.org/node/add/user-story California Nurses Association. Submit Your Story Web Site. Are you getting the healthcare you need when you need it at a price you can afford Nearly 48 million Americans have no health insurance at all and nearly 50 million more are under insured with high deductibles and co-pays discouraging them from seeking the care they need in the preventative stages. We've created this form to collect your stories which may be used on our websites in the news to educate the public and/or at legislative hearings. 30 http //google-sina /2008/02/21/ny-attorney-general-investigation-highlights-problems-in-navigating-out-of-network-charges/ N.Y. Attorney General Investigation Highlights Problems In Navigating Out-of-Network Charges 31 http // sfgate /cgi-bin/article.cgi f=/c/a/2008/02/14/BUGGV1ML2.DTL Legislation would crack down on insurers. Victoria Colliver San Fransisco Chronicle Staff Writer Thursday February 14 2008. A California lawmaker introduced legislation Wednesday that would require health insurers to get permission from state regulators before retroactively canceling a member's coverage. The bill introduced by Assemblyman Hector De La Torre D-South Gate Los Angeles County comes on the heels of news this week that Blue Cross of California had been sending letters to doctors asking them to report pre-existing conditions and discrepancies that could be used to cancel a new member's policy. 32 http // nyas.org/publications/sciences/pdf/ts_01_94.pdf Clinton Health Care Proposal called Managed Competition Jan 1994 starts on page 6 of document. Under managed competition all doctors and other caregivers will be under the administrative thumb of six or eight immense for-profit insurance companies which will have gobbled up hundreds of smaller insurers. 33 http // themoneytimes /articles/20061016/unitedhealth_shakes_up_over_options-id-101879.html UnitedHealth shakes up over Options by Shubha Krishnappa - October 16 2006 The Money Times. McGuire the longtime chief executive of UnitedHealth Group Inc. who worked hard to turn the Group into a behemoth in its field was forced yesterday to resign from the company and to give up a portion of the $1.1 billion he holds in severely criticized stock options. The options that McGuire had been granted over the years have led to criminal and civil investigations and public disapproval. 34 http // floir / Florida State Office of Insurance Regulation. The Office serves Floridians through its responsibilities for regulation compliance and enforcement of statutes related to the business of insurance. 35 http // kff.org/consumerguide/upload/7350ConsumerGuidev4_080805.pdf A Consumer Guide to Handling Disputes with Your Health Plan or Insurance Carrier - Kaiser 36 http // amazon /Making-Them-Pay-Insurance-Managed/dp/0312267606 The Book Making Them Pay How to Get the Most from Health Insurance and Managed Care by Rhonda Orin "It's time to get down to business-and that means learning the nuts and bolts of health plans..." 37 http // amazon /Fight-Back-Win-Health-Insurance/dp/0887231721/ref=pd_sim_b_img_1 The Book Fight Back and Win How to Get HMOs and Health Insurance to Pay Up by William Shernoff Lawyer who won 9 million dollar settlement from Helath Net last week. 38 http // advocacyforpatients.org/health.php Advocacy for Patients with Chronic Illnesses Jennifer C. Jaff attorney and founder of Advocacy for Patients with Chronic Illness Inc. a tax-exempt organization that provides free information advice and advocacy services to patients with chronic illnesses 39 http // advocacyforpatients.org/healthtalk%20transcript.pdf Interview with Jennifer Jaff talking about finding and getting health insurance and then making them pay for your medical bills. 40 http // sbd-law /Bio/WilliamShernoff.asp Law Firm of William Shernoff 41 http // msnbc.msn /id/23307983/ Insurer fined $9M for dropping cancer patient. Cancellation had left woman with more than $129 000 in unpaid bills. Insurance company pays up. Feb. 23 A woman battling breast cancer had her policy cancelled during her treatment. NBC's Chris Jansing reports that action is costing the insurance company dearly.Associated Press. LOS ANGELES - A woman who had her medical coverage canceled as she was undergoing treatment for breast cancer has been awarded more than $9 million in a case against one of California's largest health insurers. Patsy Bates 52 a hairdresser from Lakewood had been left with more than $129 000 in unpaid medical bills when Health Net Inc. canceled her policy in 2004. On Friday arbitration judge Sam Cianchetti ordered Health Net to repay that amount while providing $8.4 million in punitive damages and $750 000 for emotional distress. 42 http // myfloridacfo /Consumers/medical_provider_request/index.htm Florida State Division of Consumer Services Medical Provider Informational Memorandum Attention Florida Medical Providers Assistance Complaints Inquiries online inquiry form. The state regulatory agency with file inquiry with the insurance company. 43 http //blogs.wsj /law/2008/02/14/ny-ag-on-unitedhealth-database-garbage-in-garbage-out/ February 14 2008 NY AG on UnitedHealth Database Garbage In Garbage Out Posted by Dan Slater New York Times 44 http //blog.hittransition /2008/02/denial-engine-v.html What is a Denial Engine That's the computer software that denies your claim. Read more here Denial Engine Vendor Ingenix Keeps more than Usual and Customary Dollars. In my warnings to providers about denial engines those sophisticated analytics tools that payers are increasingly using to reduce deny or re-collect claims payments I try to emphasize that they can be used ethically. 45 http // usatoday /money/industries/health/2008-02-20-cancel_N.htm#uslPageReturn States act to protect individual health insurance coverage By Julie Appleby USA TODAY 2/21/08 46 http // businessinsurance /cgi-bin/news.pl newsId=11043 UnitedHealthcare settles claims dispute Sept. 06 2007 By Joanne Wojcik NEW YORK—UnitedHealthcare will pay $12 million in penalties and overhaul its claims handling practices under a settlement announced Thursday with 37 state insurance departments. Total penalties could rise to as much as $20 million if additional states join the agreement UnitedHealthcare said. The Minnetonka Minn.-based unit of UnitedHealth Group investigation by 37 state regulators following nationwide complaints about coordination of benefits appeals and grievances explanation of benefits letters utilization review procedures and other areas of claims handling. There were numerous claims processing errors such as not applying correct fee schedules and deductibles according to the New York State Insurance Department. 47 http // themoneytimes /articles/20061016/unitedhealth_shakes_up_over_options-id-101879.html McGuire the longtime chief executive of UnitedHealth Group Inc. who worked hard to turn the Group into a behemoth in its field was forced yesterday to resign from the company and to give up a portion of the $1.1 billion he holds in severely criticized stock options. The options that McGuire had been granted over the years have led to criminal and civil investigations and public disapproval. 48 http // latimes /news/local/la-fi-insure23feb23 0 187355.story Health Net ordered to pay $9 million after canceling cancer patient's policy Rick Loomis / Los Angeles Times. Patsy Bates a breast cancer patient whose medical coverage was canceled by her insurer was awarded more than $9 million today in a case against Health Net Inc. one of the state's largest for-profit insurers. The punitive damage award is the first of its kind and has prompted the giant medical insurer to scrap practices that have recently come under fire. By Lisa Girion Los Angeles Times Staff Writer February 23 2008 49 abcnews.go /GMA/OnCallPlusBreastCancerNews/story id=4338818 Health Insurer Must Pay $9 Million for Canceling Sick Woman's Policy After Precedent-Setting Judgment Health Net Said It Will Stop Controversial Practice ABC News 50 http // calendarlive /media/acrobat/2008-02/35955051.pdf actual pdf file of court ruling documents of patsy bates settlement against healthnet c 2008 jeffrey dach md all rights reserved disclaimer Original article available here Jeffrey Dach MD drdach disclaimer c 2008 all rights reserved Jeffrey Dach MD Posted by Jeffrey Dach MD at 02-24-2008 Categories Health Tags United HealthCare Kevin M. McCarty Andrew Cuomo Health Health Insurance Health Net Rocky Delgadillo Previous Post Next Post Trackbacks Trackback specific URL for this post No trackbacks exist for this post. Comments Display comments as Linear Threaded Page 1 of 1 02-24-2008 Rod Newbound RN wrote Thanks Dr. Dach for your informative blog post. The average consumer is not the only one at the mercy of the insurance companies. The physicians I talk with are only getting about 65 cents on the dollar from both the insurance companies and Medicare/Medicaid. And then there are the long term care companies... As a management level nurse I am well aware the insurance companies frequently take months to pay the bills for their patients even when a case management nurse hired by the insurance company approves services every step of the way. And I've seen multiple cases where they don't pay at all. Since nursing homes are one of the most highly regulated segments of health care they have very little recourse besides hiring an attorney for each case. In my opinion this will not get better until we put health care responsibility back in the hands of the consumer through more direct vehicles like Health Savings Accounts. Then and only then will the marketplace work the way it should. Rod Newbound RN ________________________________________________________________________ Thanks Rod for your comment. warmest regards Jeffrey Dach MD drdach disclaimer Reply to this 02-27-2008 Martin Jensen wrote Dr. Dach - A more overtly profit-oriented "revenue retention" phenomenon is the new technology I've been blogging about for a couple years now the sophisticated analytics tools that allow payers to deny and discount claims to the tune of 4% or more of previous outlays. I've dubbed these tools "Denial Engines " and I'll be giving a webinar on them tomorrow and Thursday. Check out the posts I've done on the issue at http //blog.hittransition /denial_engines/ Defeating the Denial Engine How a New Breed of Software is Bleeding Providers Dry and How to Build Buy or Demand Tools and Techniques to Put a Stop to It . There is a new category of software tools that payers are bringing to bear on the adjudication process that is an order of magnitude more sophisticated than providers have faced in the past. So sophisticated that some of the vendors don’t even charge a license fee – they just collect a contingency on the millions of dollars that get stripped out of providers’ monthly checks. So deep and so broad is the technology that it allows the payer to set a tolerance level – what percent of outbound revenue do you wish to retain How much will your providers put up with Marty Martin Jensen Healthcare IT Transition Group 918-630-4417 m Presenter Defeating the Denial Engine http // hittransition /flashpoint/ Reply to this 05-14-2008 LR wrote Dear Dr Dach I have had 2 cancer surgey's and radiation therapy. I used network providers some of whom are at the cancer centers. BlueCross/BlueShield and United Health Care are refusing to pay the clinic charges amounting to 1 000's of dollars. These are bills from the network hospitals that have these cancer centers. The hospitals are billing me directly saying it is my responsibility to pay since the insurance company will not pay. I have of course filed an appeal waiting for a decision. If I am turned down I will go to the next level. The end result is that the health insurance company is refusing me medical coverage for their assigned physicians in the network because these docs are based in cancer centers at hospitals. The stress is not helping my cancer recovery. My guess is that the insurance company hopes that I expire ASAP. I always did the right thing but Hospital Corp of America will have the last laugh. LR ______________________________________________________________________ Dear LR Thanks for your comment. The health insurance industry is a big part of the problem. The solution is for the states to regulate health insurance industry same as a public utility just like the electric company is regulated. warmest regards Jeffrey Dach MD drdach disclaimer Reply to this 01-04-2010 australian health insurance wrote I have take a Health insurance policy from ICICI lombard. But I have lost my card which they have issued me Reply to this 02-17-2010 Diane Jones wrote The Patsy Bates story was horrendous - according to the version I heard Health Net cancelled because she had failed to tell them that she had acne in her teenage years. I know that health issues can be complicated but … Good to see that one bad insurance agency won’t be able to continue giving the rest a bad name. Reply to this 02-24-2010 cynthia allingham wrote My insurance company will not pay for my hormones because I get them from a compounding pharmacy. But they are willing to pay for all the expensive drugs that most women my age take. cynthia allingham _________________________________________________________ Jeffrey Dach MD drdach disclaimer Reply to this 03-31-2010 david wrote My sister got all the info she needed from here http // expatriate-medical-insurance.org/ She was going to a high aids area so it was harder to the get the correct cover David Expatriate Medical Insurance Reply to this 04-25-2010 Dave wrote While you make good points you also put an image forth that is not entirely accurate. I was CEO in a major insurer for years. I left the industry because of the change in attitude about clients. The industry used to look for ways to help people but with the advent of managed care that changed. The companies were no longer run by businesspeople with customers as their number 1 concern. Rather financial people and doctors took over. There was a push to keep as much money as possible. Add to that on the other side of the equation that MANY providers doctors hospitals etc. learned to game the system to rip off insurers and the war was on. Providers were very guilty of ripping off insurers. I ran a study in the 1980s in South Florida while I was still in the industry. We proved that 48% of all claims submitted by doctors in that region to our company were fraudulent. The problem is greed. I left the industry over it and warned the industry that if they didn't correct their actions that national health care would occur and they would lose their industry. The providers will lose too. Government cannot run anything well. They will increase administrative costs ration care and the public will suffer along with providers. Insurers will not only suffer they will cease to exist in many cases. On the other hand the complaints of people that certain things are not covered when they are legitimately excluded from coverage is something Americans refuse to understand. My doctor prescribes maintenance medications for me and my insurer only covers two of them. The other one costs me about $80 a month. My doctor and his staff can't understand why it isn't covered and think I am being ripped off. The fact is that this medication is specifically excluded from coverage. That means that if I want it I have to pay for it myself. Americans want health insurance to pay for everything. If your auto insurance paid the way people want health insurance to pay then it would pay for your gasoline and oil changes. Health insurance should be for catastrophic issues. People should be responsible for the first few thousand dollars of care each year. It would make them better patients. But greed on the part of the consumer is just as bad as on the part of providers and insurers. People want everything for nothing. They won't live a simpler lifestyle to have savings to cover a few thousand dollars in other expenses such as healthcare. Instead they borrow money to pay for everything from homes to cars to everyday purchases. This problem is not going to get solved. The government is going to end it with healthcare reform and everyone will regret it in the future when the truth of it all comes out. People need to start thinking about how they will handle their healthcare needs when the government rations care and consumers will just like in other countries with socialized medicine not be allowed to purchase care outside the system. Reply to this Page 1 of 1 Leave a comment Enter the above security code required Name required Email will not be published required Website Your comment is 0 characters limited to 3000 characters . Subscribe to this post Subscribe to this blog Remember me c Copyright 2010 11 All Rights Reserved Jeffrey Dach MD expressing emergency insurance private . plan as maintenance pay early obtaining Insurance waives health organization of a type quick that the ways legal admitted 2007-11-19 health

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