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One of the things I liked about this is that it make the insurance plan sound like an evil enemy out to get you. My understanding is that besides trying to catch those committing fraud, and looking for providers who are not aware they are doing things wrong, with all insurance plans a number of random audits are required by the organizations that credential insurance plans for quality assurance, so you may be chosen randomly. You may also be targeted if a client complains about you to the plan.
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I found it here:
She claims this is only for those who "can afford health insurance" but get it.
Be nice if address the ACTUAL problems in health care instead of abetting the two villians:
a meddling government that drives costs up and refuses to enforce antitrust laws or contract law against the greedy handful of insurers who control health care in the US.
Linda Peeno, MD testified that SHE had often denied treatment JUST to save the insurance company money
"the vast majority of health insurance policies are through for-profit stock companies. They are in the process of “shedding lives” as some term it when “undesirable” customers are lost through various means, including raising premiums and co-pays and decreasing benefits (Britt, “Health insurers getting bigger cut of medical dollars,” 15 October 2004, investors.com). That same Investors Business Daily from 2004 noted the example of Anthem, another insurance company. They said the top five executives (not just the CEO) received an average of an 817 percent increase in compensation between 2000 and 2003. The CEO, for example, had his compensation go from $2.5 million to $25 million during that time period. About $21 million of that was in stock payouts, the noted.
A 2006 “U.S. Health Insurance: More Market Domination, More CEO Compensation”
(hcrenewal.blogspot.com) notes that in 56 percent of 294 metropolitan areas one insurer “controls more than half the business in health maintenance organization and preferred provider networks underwriting." In addition to having the most enrollees, they also are the biggest purchasers of health care and set the price and coverage terms. “’The results is double-digit premium increases from 2001 and 2004—peaking with a 13.9 percent jump in 2003—soaring well above inflation and wages increases.’" Where is all that money going? The quotes a Wall Street Journal looking at the compensation of the CEO of UnitedHealth Group. His salary and bonus is $8 million annually. He has benefits such as the use of a private jet. He has stock-option worth $1.6 billion."
–Save America, Save the World by Cassandra Nathan pp. 127-128
And read on:
"While growing into a colossus, UnitedHealth has repeatedly failed to perform its basic job of paying medical bills. UnitedHealth, which covers 70 million Americans, has been sanctioned in nine states for paying claims slowly; doctors, hospitals, or patients; or poorly handling complaints and appeals.
One Nebraska woman complained to state regulators that computers had incorrectly rejected claims related to her surgery six times.
At one point, UnitedHealth owed Dr. George Schroedinger, an surgeon, $600,000. He and his clinic sued UnitedHealth of the Midwest in 2004.
Deciding for the clinic, U.S. District Judge Stephen Limbaugh of Missouri declared that the claims processing systems were "flawed in many ways, denying, reducing, and improperly processing claims on a regular basis. And despite innumerable requests, United was unwilling to remedy the underlying errors in its systems" (Star-Tribune Dec. 12, 2007).
Payment troubles continued after the verdict, and Dr. Schroedinger filed a second lawsuit. "These people can never get it right, which says to me that they just plain lie," he said in an interview.
Failure to pay the only complaint. The insurer also gives incorrect information on which physicians are in its network, creating enormous problems for staff.
The AMA said that no other insurer has prompted as many complaints as UnitedHealth about abusive and unfair payment practices. AMA officials have met with UnitedHealth executives 16 times since 2000, with little to show for it.
"They have always got a new plan to fix it," said Dr. William G. Plested III, past president of the AMA. But "nothing ever happens."
It seems to us that this case is just the tip of the insurance iceberg. More and more stories are appearing daily in the news media about how insurance company are instructing employees their jobs are to deny claims and/or delay payments.
With such a high percentage of medical premiums and other costs going to the legal profession, to maintain compliance with endless government rules/regulations and being hoarded by the insurance companies and executives — is it any wonder medical costs are increasing so dramatically?
time to take a closer look at the medical insurance companies.
UnitedHealth Group is not the first medical insurance company to rob patients, hospitals and clinics to pay obscene salaries to their executives.
a modern day robbing patients to pay pimps.
Michael Arnold Glueck, M.D., comments on medical-legal issues and is a visiting fellow in economics and citizenship at the International Trade Education Foundation of the Washington International Trade Council.
J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons.
Why is government constantly attacking the working poor at the expense of their "buddies"? IF insurance companies were paying legit claims AND turning a profit, that would be fine. Instead, reaping vast sums of blood money at the taxpayers expense.