Gramof6

Dealing with any type of Insurance stuff is so confusing to me, ya might as well plunk me down, smack dab in the center of China or Japan & expect me to understand the language. Do you have Ins. Marsye with United Health Care? We don't.

marsye

Yes we do thru my hubs former employer.

seamstome

I do this for a living and have a some money coming--when CIGNA settled I got enough to buy my sewing machine.

Here's the scoop. When the insurance companies determine "usual, reasonable and customary", they were supposed to do a survey to find out what the prevailing rate was. They said they were using an independent company called Ingenix to do the survey. Amazing enough in 32 years of doing this, Ingenix has never surveyed me and they have always told me I was 35% over the prevailing rate. However, when I have my office manager call around to the closest 25 offices my fees are about mid range. Imagine this....Ingenix is not independent but an arm of UHC, Aetna, CIGNA and Wellpoint.

Attorney General Cuomo of NY nailed these companies. Each is settling out for millions when they saved BILLIONS by not paying 80% of the true prevailing cost thus charging the person for an 80% policy when they truly only paid 50% of the true prevailing rate. Because you could not fight this inequity on your own as a Doctor, this FORCED doctors into being in network or it forced them into bankruptcy as patients flocked to in network doctors for fear of being STUNG with a huge difference that the insurance would not cover even though by contract they should have.

If you went to an out of network provider during that time and had to pay the difference between what UHC said was prevailing and what was truly prevailing you are supposed to get money back.

Now for the rest of the story, just look at the stock prices of CIGNA, UHC, Wellpoint and AETNA from 2000-2008 when they were running this scam. Many of their stocks went up ten fold. They were increasing premiums, decreasing in network payments to the doctors and at the same time illegally capping out of network payments.

They actually should go to jail because this wasnt just a game to cap out of network benefits but a game to manipulate stock prices.

Tink's Mom

I was tempted to toss the paperwork because there was no way that I could make heads or tails out of it after reading it thru a couple of times....
With all the money we have paid to them over the years.... :?:

Gramof6

We have Cigna & I do not like it. But? It is what my DH's job provides. I chose to stay with my Dr even though she is out of network and it is ridiculous what I pay! I believe I pay 60% for ea visit. For a darned Pap test, it was almost $400. I about croaked! Where I have to get my labwork done it is out of network & cost me $150. When we had Blue Cross labwork was fully covered and so was the Pap test. Grrrr I do not like Cigna.

seamstome

Imagine being one of the doctors, luckily we have computer records. On the CIGNA settlement over the expanse of that many years I had billed over a million and I got 1100 back!

Im telling you right now, it was all a game. When this all started in the early 90's, Americans did not want HMO's or PPO's. Remember the revolt about Clintoncare. By assuring people they could get out of network benefits (the big LIE), it sweetened the deal enough that now 90% of Americans are in some kind of managed care plan. Then they just didnt pay the out of network benefits but by then the paradigm had shifted and just like quicksand you could not get out.