UnitedHealth Group Ripping Off Insureds

"What in the world is this charge for?" or "Why am I being charged that amount instead of this amount?" or more importantly "Why isnt my health insurer paying for this procedure?" All frequently asked questions for insurance companies customer care representatives.

New York Attorney General Andrew Cuomo may have your answer:

The New York attorney general’s office launched an investigation after
receiving hundreds of complaints about Oxford Insurance and its parent company,
UnitedHealth Group, which claims to rely on “independent research from across
the health care industry” to determine reimbursement rates. In actuality though,
it relies on Ingenix, a research firm owned by UnitedHealth Group.

UnitedHealth Group is the parent company to many smaller companies, including United Health Care and Ingenix, both of which have healthy market shares in Wisconsin. Disputing the "usual and customary, or reasonable charge" is par for the course with all insurance companies. But using an "in-house research firm" touted as "independant research from across the health care industry" to short change insureds is nothing short of astounding.

The $50 million dollar slap on United's wrist will be used to create a non-profit to determine reimbursement rates for its patients. (Which begs the question, shouldnt this have already been done with premiums rather than punitive awards for ripping off customers for years and years?) So, consumers are unlikely to see a dime of the award. Does UnitedHealth Group's duty of good faith to its insured warrant a reimbursement without any action by the insured????

Lawyers in Wisconsin are well aware of Insurer's using Ingenix and their most recent tactic of reducing the "reasonable value" of charges submitted by hospitals, doctors, clinics, etc. In its simpliest terms, reducing the "reasonable value" ultimately devalues the amount of medical bills an injured party may recover, which in turn lowers the amount the injured may receive from an at-fault party. Lawyers representing injured individuals should be leary of any numbers Ingenix comes up with and should inquire with the Ingenix representative as to its methods of calculations.