Health Insurance And What They Pay Doctors

People living in Grand Prairie, Arlington, Dallas, Fort Worth, Weatherford, or any where in Texas or the nation have a hard time understanding how their health insurance works when it comes to paying medical providers. This is particularly true with the “out of network” medical providers involved in a health claim.
The Palm Beach Post recently published an article. The article addressed the possibility that a class action lawsuit was going to get traction against some of the larger medical insurance companies. The Palm Beach Post article is titled “Lawsuits Filed Against Blue Cross Claims Reimbursement Rates Kept “Artificially” Low”.
The first line in the article starts out; “Ever wonder why your insurance company claims a procedure that cost you dearly could be gotten for a fraction of the price you paid?” An example of this is given in the article where a Palm Springs resident was charged $1,210 for an MRI. Blue Cross said the cost should have been $419. Since he had not met his deductible, it would not cover the MRI. Further, it would not allow him to claim the full amount toward his deductible.
The lawsuit, which was filed in United States District Court, claims this happens because the so-called “usual, customary and reasonable rate” most insurance companies use to determine how much they will pay are “rigged to artificially deflate” the cost of the treatment. This practice effects consumers who use doctors who do not participate in their health insurance plans and the physicians who provide so called out-of-network services.
Some of the insurers who use the same methods as Blue Cross include, United Healthcare, Aetna and Cigna. They use the same flawed ways of calculating rates as Ingenix, a Minnesota based health data company.
As the article points out, these same insurers and Ingenix last year, agreed to pay a total of $100 million to help start a nonprofit to determine how much insurance companies should reimburse patients who see out-of-network doctors. This agreement was worked out to settle lawsuits filed by the New York Attorney General office. The database that will replace Ingenix, will not be in place until later this year.

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