Senate Report: Insurers Charged 'Billions' to Consumers They Were Supposed to Pay
By Susie Madrak Thursday Jun 25, 2009 2:00pmIt's really important to understand that insurers are not to be trusted, especially now that we know they've been defrauding us all along. Former CIGNA communications chief Wendell Potter (watch the complete video here) testified before the Commerce Committee yesterday and summed it up: Don't trust the insurance companies.
Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released today by the staff of the Senate Commerce Committee.
The report was part of a multi-pronged assault on the credibility of private insurers by Commerce Committee Chairman John D. Rockefeller IV (D-W.Va.). It came at a time when Rockefeller, President Obama and others are seeking to offer a public alternative to private health plans as part of broad health reform legislation. Health insurers are doing everything they can to block the public option.
At a committee hearing today, three health care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that fail to cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."
The star witness at the hearing was a former public relations executive for major health insurers whose testimony boiled down to this: Don't trust the insurers.
"The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent and accountable -- publicly accountable -- health care option," said Wendell Potter, who until early last year was vice president for corporate communications at the big insurer CIGNA.
Potter said he worries "that the industry's charm offensive, which is the most visible part of duplicitous and well-financed PR and lobbying campaigns, may well shape reform in a way that benefits Wall Street far more than average Americans."
Insurers make paperwork confusing because "they realize that people will just simply give up and not pursue it" if they think they have been shortchanged, Potter said.
Sen. Mike Johanns (R-Neb.) questioned the government's ability make matters clearer, saying federal regulation of mortgage disclosures have made the documents borrowers encounter in real estate transactions "hopelessly complicated."
Asked to address the hearing testimony, Robert Zirkelbach, a spokesman for the industry group America's Health Insurance Plans, said insurers have proposed "overhauling the market rules and enacting new consumer protections so nobody is left out, simplifying health care choices for individuals and small businesses, and reforming the delivery system to improve the quality and affordability of health care coverage."
The report released today alleged that insurers have systematically underpaid for so-called out-of-network care. The issue had been brought to light previously in litigation, committee hearings, and other investigations, including a probe by New York Attorney General Andrew Cuomo. But as politicians and interests groups clash over the current effort to overhaul the nation's health care system, it took on new relevance.
Cuomo described it last year as "a scheme by health insurers to defraud consumers by manipulating reimbursement rates."
Many Americans pay higher premiums for the freedom to go outside an insurer's network of doctors and hospitals. When they do, insurers typically pay a percentage of what they call the "usual and customary" rates for the services. How insurers determine the usual rates had long been opaque to consumers and difficult if not impossible for them to challenge.
As it turns out, insurers typically used numbers from Ingenix Inc., which was a wholly owned subsidiary of the big insurer UnitedHealth Group. Ingenix had an incentive to produce benchmarks that low-balled usual and customary rates and shifted costs from insurers to their customers, the report said.
Ingenix got all of its data from the same insurers that bought its benchmark information, the report said. Insurers that contributed data to Ingenix often "scrubbed" their data to remove high charges, and Ingenix further manipulated the numbers, removing valid high charges from its calculations, the report said.
Cuomo found that insurers under-reimbursed New York consumers by up to 28 percent, the report said. A dozen insurers have reached settlements agreeing to change their practices; UnitedHealth agreed to the largest payment, $50 million, which will help a nonprofit organization set up a new database to replace Ingenix.
In March testimony to Rockefeller's committee, UnitedHealth chief executive Stephen J. Hemsley said UnitedHealth stands by "the integrity of the Ingenix data."
Ingenix performed an important function, Hemsley said, because paying whatever doctors charge "is simply not economically tenable."









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Insurance companies are supposed to collect premiums and then pay for medical coverage if it becomes necessary, but in actuality their business model is to collect premiums and then do everything they can to NOT pay for medical coverage.
" insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that fail to cover needed care."
I am stunned! I was under the impression that America had the best health care system in the world and that health insurance companies and HMOs are so concerned about their clients' well-being that they routinely lower premiums, copays and deductibles- even offer refunds and incentives to people who have been healthy or who have made healthy lifestyle changes. And the CEOs decline raises and bonuses, instead donating that money to charitable organizations helping sick children whose parents are too poor to afford doctors.
Wendell Potter piece in Counterpunch and my earlier comment here
Obama's responsible. (this should have been under the first comment about Michael Jackson's death).
how the major networks report on this report. Let's see Diane and Charlie frame some questions around how we have left HMO's have so much power.
Meanwhile John Kerry is touting triggers--http://www.huffingtonpost.com/2009/06/25/kerry-pushes-for-public-o_n_220822.html
Why are the Dems so far behind the people???
1) We need campaign finance reform. Let's use triggers on how much $ politicians receive.
2) If we are going to have a 2-party system, let's push out Dems who won't stand for single-payer, gay marriage, cuts in defense spending.
That "trigger" is the first thing I thought of too.
Sure the insurance companies will bring down the cost of medical insurance - by stiffing their insureds and cutting them off when they need it most. Does anybody seriously think they'll "cut costs" through some magical reduction they've never seen before?
Even the pathetic "public option" should not be tied to any trigger these bastids have any control over.
I've been interpreting the whole cutting costs thing as them more or less admiting to profiteering, and now that they're caught, and the people are up in arms, they're gonna sacrifice some of their profits to provide better service.
I don't actually believe they'll follow through, but I doubt there's much they can do to substantially lower administrative costs, which leaves their need to generate profits as the real issue.
They keep saying that a public option could cost up to 3 trillion in 10 years. What would the cost of private insurance cost in 10 years? I will bet that it will be one hell of a lot more.
In 10 years, it will be totally free.
The administrative costs are easy to deal with: No profits allowed. This cannot be a "for profit" transaction under any circumstances ever. Too bad for the big greedy corps running it all now.
Doesn't work. Too many ways to skim money without showing profits. Huge salaries and benefit packages. Payments to service providers for non-existent services. Fraud. And don't forget that health care providers incur some $30 billion annually in administrative costs simply to deal with insurance companies.
Aside from the fact that the shareholder model no longer holds if it is not-for-profit.
The House and Senate are considering a mandate that everyone buy insurance with the poor being be subsided by the government. If there is no public option because of a trigger, the insurance companies will suddenly have millions of new customers. You can bet the triggers will be rigged to never be pulled. They will then have millions of new customers subsided by the government. Chaaa Ching!!!!!
The two-party system is a joke. There are a few Dems who represent the middle/working class, but I think it should be evident by now that most of our Congresspeople don't work for our interests. If they did- and if the Democratic Party was really concerned, they would be fighting for Single Payer. In case you don't remember, check out what Obama said in 2003: http://www.youtube.com/watch?v=fpAyan1fXCE
Ok, Mr. President, you said "First we have to take back the White House, and we have to take back the Senate..." The conditions are favorable, so where is it?
There is no two party system left. That sucking sound that you hear are politicians, one after another, being bribed into representing only corporate interests. Why do you think Cheney started the Iraqi business? To enrich Halliburton and thus himself. He never gave up his stock options, and no one ever called him on it. And this isn't even the tip of the iceberg, it is a snowflake on the iceberg. We have to stop bitching and do something about this. Unless it's too late. Then we all need to move to a different country and let them have this one.
Tax revolt. Stop feeding the bastards and maybe they will begin to pay attention.
You want public health care? Stop paying private health insurance. If a lot of people did it the insures would go bust and Uncle Sam could step in and offer a real health insurance system paid for by the premiums now going to the crooks.
That way, I could have saved the 25% of my salary that goes to my insurance and the medical expenses above what insurance paid for my surgery. Instead, I could have just been in debt for 300% of my yearly salary.
Yeah, that's a good idea.
...a two party system, we have Republicrats that are beholden to their corporate masters. We don't live in a democracy and haven't for some time.
Nothing will change because the majority of Americans either don't care or refuse to recognize the problem.
Get used to it.
why has a class action lawsuit not been filed already
The burden of proof in a criminal case is "beyond a reasonable doubt," the highest standard of proof. In a civil case, much lower. It kind of guarantees a win. Score! Us NY'ers are really proud of Andrew Cuomo...and his Dad.
of insurance companies, they bank on people not reading, not understanding if they do read and not challenging anything.
Sheeple.
does anyone have a choice?
Don't buy in.
.
Color me shocked!
This means nothing folks, the fix is in. Not just the usual republicans but enough of the democrats to. Enough of them have been bought off by the health insurance and drug industry that no meaningful health care will pass. Forget single payer, I am talking about even a public option. Ain't going to happen.
When the sellout happens you will hear lots of nice words from pols and msm about bipartisan, moderate, and compromise crap like co-ops etc. to coverup their failure to help the American people as they con the country into believing that they accomplished something important. Don't believe it. Even if Obama says it, God forbid.
We are in for a monumental sellout. The right will celebrate (quietly if they are smart...oh ya, forget that), the progressives will wail to no effect, and the rest will lap up compliments about how reasonable and moderate they are to accept...nothing! They won't figure out what a screw job they got until they or their families are sick and need coverage. It won't be there and it is going to get worse every year until ....?
Even more true today. The fix is always in.
Now I understand more the politics of hydrocarbon man, his rise and fall.
Neo-Feudalism is the coming thing.
The near-bankruptcy of rural and small-town hospitals due to unreimbursed care, and the decision of low-paid workers to decline overpriced policies which cover no more than a stripper's G-string, indicate that some type of health package will be legislated to subsidize the corporations and "non-profits" who own these hospitals. Taxpayers are not being subsidized, business is, and the right will cry crocodile tears when the bill passes, to distract us from the Federal money they will be stuffing in their pockets.
Meanwhile, I see the same extended white organized-crime family running the billing dept at our local hospital, heading a regional hospital across the state line, owning a small rehab hospital, and owning a NASDAQ-ticker medical company. This scenario will repeat across Ohio, North Carolina, Tennessee, and probably other places. The health-care subsidy plan is Obama's gift to his white shirttail kin, not to the suffering patients.
I caretake a disabled man. His Medicare bills show double-billing on each line by both the local hospital and by his physician's office. MSM reported years ago that the Mafia has moved into health care and is milking it dry. A single-payer system should be combined with stringent oversight and severe penalties for fraud.
Senator Rockefeller presided over a committee hearing and was accompanied by 1 other Senator. ONE!
It is a joke that no one was there to hear the damning testimony presented today by Mr. Potter and Ms. Metcalf.
The capitol hill politicians complicity in trying to sink meaningful health care for all must be exposed. It is really an outrage.
"Charm Offensive" That describes the Insurance Industry's recent willingness to cooperate with the White House to a T! Pity that the President, desperate to have consensus, seems to have fallen for the tactics of these snakes.
You cannot classify everyone in two buckets right and left. There are all kinds of variations in between. This is not a simple fix.
Political right and left is largely an illusion. The real division is corporate (98%) and humanitarian (2%).
Insurance, really is a mob thing. It takes that mentality to rob someone for their "lack of faith" in themselves. Why did Senator Rockefeller allow only one other to be in the room? This issue is so big it needs "connection".....How many, Milesasd, really attended? The article seems to "imply" several.
Is this another insurance scam?
at this??
What is shocking to me is the 'lay down & take it' mentality with way too many people in the States.
Sure, there are lots of people outraged & calling for 'single payer' health coverage...but words & ads mean nothing so long as the money-grabbers get to keep on grabbing your hard-earned dollars.
Whatever this 'public option' talk means, or doesn't mean, is a moot point anyway, seeing as not even that will make it through.
Matters not...single payer is the most efficient & beneficial to all, type of healthcare. Without researching & maybe even 'giving it a trial run' in a smaller demographic...how will you ever know?
Keep on being 'thankful for the crumbs tossed your way' and you shall evermore be 'just picking up crumbs'.
Change is sometimes necessary & sometimes people just have to get off their collective couches & do something more than whine.
If this thing they keep calling a 'free market' can be so devastated by competition and transparency, is it really a free market? And if it's really something else (say, legalized extortion) masquerading as a free market, shouldn't there be investigations that lead to criminal prosecutions? Don't we have laws about stuff like that?
I chose an out-of-network medical facility to receive state of the art surgery for a herniated disk in my lower back, which allowed me to return to work in only 3 days.
First of all, even with detailed procedures provided by the surgeon, Blue Cross/Blue Shield was unable to tell me how much they would cover. They simply said some charges could only be determined after the procedure. It seems my doctor had plenty of experience with BC/BS, and offered me a decent deal for a cash payment up front. At the time, I felt this cost was still too much, went ahead and agreed.
The surgery cost $51,000. My wonderful insurance company denied over $48,000 of those charges.
I agreed to pay $15,000 to for the surgery, and they guaranteed this would be the most I would pay. If I hadn't agreed to this deal, I would have been responsible to pay $48,000 myself.
Not only did I have to pay my regular insurance premiums, I paid another 15 grand on top of that, and BC/BS profited handsomely from my business because they didn't pay for hardly anything.
The "out-of-pocket" maximum for out-of-network services is a TOTAL SHAM.
I was lucky I could afford to have the best treatment I could find. I think it's wrong to coerce people who have less money to stay in network. It is wrong to mislead policyholders with false out-of-pocket maximums. It's wrong we can't know the true cost of operations before they are performed.
Now I can see how easy it is to find yourself bankrupt because you don't realize how underinsured you really are, and insurance companies make it almost impossible for you to know the real risk.
This really shows the true problem with health care in the United States. Insurance.
The basic proposition of insurance is this: you place a bet with someone that you are going to get sick or die.
You keep doubling down every month in the form of premiums as long as you are healthy. Betting against your own health and well being.
Meanwhile, Mr. Insuranceman takes your bets and invests part of it and spends part of it on himself and his cronies.
When you finally "win" your bet by getting seriously sick, your bookie looks for every angle to welsh, knowing that you are now over the barrel and desparate.
Keep this in mind when you hear about public option saving $1.2 Trillion. "Saving"? That means somebody, namely the Insurance Bookies, would not be getting. and $1.2 TRILLION is a whole lot of cabbage to leave on the table so don't think for a second that anything like a pesky 80% of citizen wishes or the national Treasury or our economic and industrial viability will get in the way.
Look for bought and paid for Congress and, unfortunately, Mr. GetAlong Obama, to roll over and pass a "reform" law that requires everyone to place their bets against themselves.
Talk about sick.
http://www.opednews.com/articles/Health-CARE-...
http://www.opednews.com/articles/Health-CARE-...
If YOU are having a heart attack,WHO YA GONNA CALL? WALL STREET? Get REAL!!!
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