Insurance companies pull a fast one on consumers

Posted April, 24 2012 by arianne

Did anyone read the Times this morning?

There’s an article out by Nina Bernstein about the latest in what seems to be an ever-growing list of insurance company shenanigans.  This time, it has to do with provider reimbursement rates for out-of-network care.

You see, back in 2009 the state reached a settlement with insurance plans that required them to create a new database which used a fair method for calculating reimbursements to providers.  The insurance plans dutifully did as they were told and created this new database, at a cost of $95 million.  The problem is, they never used it.

Instead, they came up with a different way to price reimbursements, which ends up costing patients who must rely on out-of-network care much, much more. And, while this issue of pricing out-of-network reimbursements is a complex one and definitely part of a much larger problem surrounding health care costs in general, it really does highlight the need for improved health insurer regulations.  This issue is of particular importance at this moment while our state policymakers are busy designing how our forthcoming state health insurance Exchange will work.  Clearly this is an opportunity to make some much needed changes to our system!

Anyways, the article is a good one, and you should definitely check it out when you get a chance.  Click here to read today’s article in the NY Times, titled, “Insurers Alter Cost Formula, and Patients Pay More.”