You got to give Andrew Cuomo, the attorney general of NY, some credit. This dude is a serious ball buster for the managed care companies. He just got UnitedHealth to cough up $50 million for allegedly causing patients to overpay for care outside the insurer's network. Any doctor not in the network got paid up to 28% less than in-network physicians and if the doctors didn't accept those amounts as full payments, the patient had to make up the gap. What UnitedHealth and other insurers do to run this scam is to use a database called Ingenix which tweaks the payments any way the insurer wants. The patient never knows why the insurance won't pay the whole price and blames the "greedy" physician; all the while the insurance company licks its chops and cashes in. Of course UnitedHealth never admitted to being guilty (not mentioned in the linked article) and states it only settled to put an end to the lawsuit and move on. Yeah, right.
Who knows how NY will use the $50 million it is getting. They say it will go to some yet unnamed non-profit agency "that will calculate how much doctors and hospitals should be paid in the future". I won't hold my breath but I do give Cuomo credit. It seems he is going to go after other insurers as well. Why don't all the AG's of different states do the same thing? This all may force the managed care companies to stop bullying doctors and pay them appropriately as well as make it easier for patients to see the physicians they want to. Of course UnitedHealth will never allow themselves to take this financial hit and will subsequently pass this fine down to the patients one more time by raising rates by double digits again. And so it goes.