Aetna and CIGNA have been named in a lawsuit filed by the American Medical Association (AMA) over health insurance reimbursement payments.  According to the AMA, the lawsuit charges that Aetna and CIGNA used a flawed database to pay physicians artificially low rates for out-of-network care.

The database in question is operated by Ingenix Corp., a wholly-owned subsidiary of UnitedHealth Group.  The database used “usual and customary” rates  to calculate reimbursements for out-of-network care.  The AMA lawsuit seeks damages for physicians from each company commensurate with what doctors would have been paid if the out-of-network pay rates had been calculated accurately. Damages are also being sought for patients who overpaid, the AMA said. (more…)

Wellpoint and Cigna, two of the country’s largest insurers, have as agreed to stop using the much-maligned Ingenix database for determining reimbursements for customers who seek out-of-network care.  Wellpoint and Cigna are just the latest insurers to reach an agreement with New York Attorney General over Ingenix.

The Ingenix database, owned by UnitedHealth Group, is used by many insurers to  determine their “usual and customary” rates for out-of-network care.  Last year, the New York Attorney General’s office began an investigation into allegations the Ingenix database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits. (more…)

Two Buffalo, New York insurers have reached an agreement with the state’s Attorney General to stop using Ingenix, the reimbursement database owned by UnitedHealth Group.   Independent Health and HealthNow New York Inc. are just the latest insurers to agree to end their use of a database the Attorney General’s called “a defective system” to calculate reimbursement rates for patients who go out-of-network.

Independent Health, HealthNow, and many other insurers have used the th United-owned Ingenix database to determine their “usual and customary” rates for out-of-network care.  The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service and geographical location.  Under this system, insurers control reimbursement rates that are supposed to fairly reflect the market. (more…)

Cigna and Aetna  are the latest insurers to be hit with a lawsuit over the Ingenix database, which is used by many large health insurers to determine reimbursement rates.  The lawsuits, filed by the American Medical Association (AMA) and several state associations, claims that the Ingenix database was rigged to underpay doctors on out-of-network claims for more than a decade.

Ingenix is a subsidiary of UnitedHealth Group.  The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service and geographical location.  Under this system, insurers control reimbursement rates that are supposed to fairly reflect the market. (more…)

UnitedHealth Group has settled a class action lawsuit over its Ingenix database.  The $400 million settlement with the American Medical Association (AMA) comes just days after UnitedHealth settled similar charges with the state of New York for $50 million.

United and the largest health insurers in the country rely on a database operated by  Ingenix  -a wholly-owned subsidiary of UnitedHealth – to determine their “usual and customary” rate.  The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service an (more…)

UnitedHealth Group has agreed to pay $50 million to settle charges that it overcharged millions of customers.  As part of the settlement with the New York State Attorney General’s Office, UnitedHealth Group will also revise the process that health insurers across the country use to determine reimbursements when members receive services from out-of-network providers.

According to the Attorney General’s office, the settlement stems from an  industry-wide investigation begun last February into allegations that health insurers unfairly saddle consumers with too much of the cost of out-of-network health care.  According to a press release issued by the office, seventy percent of insured working Americans pay higher premiums for insurance plans that allow them to use out-of-network doctors.  In exchange, insurers often promise to cover up to eighty percent of the “usual and customary” rate of the out-of-network expenses, and consumers are responsible for paying the balance of the bill. (more…)

A risk assessment group now says damage costs from Hurricane Ike could go as high as $21 billion.  That figure would make Hurricane Ike the third most expensive storm in U.S history, behind Hurricanes Katrina and Andrew.

The new estimate from Risk Management Solutions of $13 – $21 billion is higher than the $7 – $21 billon figure the group released just four days after the Sept. 13 storm.  The damage estimates include $10 billion to $15 billion for wind and storm surge, $2 billion to $3 billion from inland wind and flood losses and $1 billion to $3 billion in offshore losses.   (more…)

As residents of the Gulf Coast work to rebuild after Hurricanes Ike and Gustav, lawmakers in one state are working on a plan to protect hurricane victims from massive insurance deductibles.  The plan being considered in Louisiana would limit insurance companies from imposing more than one storm deductible on policyholders in a single season.  The proposal is being put forward by the Louisiana Insurance Commissioner and has the backing of two key state lawmakers.

“Named storm” deductibles are imposed by insurance companies in hurricane zones from the Gulf Coast to New England.  These deductibles can be as high as 5 percent of a home’s value.  In such cases, a policyholder with a home valued at $200,000 would be responsible for a deductible of $10,000.  Unfortunately, many people are not even aware that such a policy exists until they make a hurricane damage claim. (more…)

Hurricane Ike victims in Texas are reportedly facing long waits for meetings with insurance adjusters.  Adjusters are apparently being hindered by the shear number of claims, areas that are still inaccessible and properties with damage so extensive that they require multiple inspections.  Many Hurricane Ike policy holders are understandably anxious to have their insurance claims settled so that they can begin rebuilding their lives.  But it is important that anyone with a Hurricane Ike insurance claim understand their rights and responsibilities so that in addition to having their claim paid quickly, it is also paid fairly.

According to Texas law, insurance companies usually have 15 days to start investigating a claim once a policyholder lets them know about it. But when a natural disaster strikes, the state’s insurance department can extend that deadline by 30 days. That was done on Wednesday.  Insurers can take as long as they need to investigate claims, such as sending adjusters and inspectors out to examine damages and collecting reports.  Once an investigation is complete, insurance  companies have  30 days to decide whether to pay a claim from a natural disaster, compared to 15 days in a non-disaster situation.  If the claim is accepted, the company has five days to make the payment.  If an insurance company doesn’t meet these deadlines, the state can impose fines. (more…)

A Texas consumer group is decrying the Texas Windstorm Association’s recent announcement that it won’t pay for storm  surge damage from Hurricane Ike. Because storm surge is caused by the winds that accompany a hurricane, the group Texas Watch says that such damage should be attributed to wind.

The total cost from Hurricane Ike is expected to be high.  As a result, insurers will be looking for ways to limit their exposure.  Attributing damage to storm surge, rather than wind, will help in that effort.  Texas Insurance Commissioner Mike Geeslin told a legislative panel Wednesday that more than 50,000 insurance claims have already been filed and the number could go as high as 300,000. (more…)