Read the Fine Print

The Lewin Group released a report yesterday evaluating the possible impact of a new public health insurance plan on the health care landscape. Some of the findings are decent. Some have a little bit of a “rile up the docs, hospitals, and insurers” tone.

But what’s most fascinating about The Lewin Group is this (emphasis mine):

The Lewin Group is an Ingenix company. Ingenix, a wholly-owned subsidiary of UnitedHealth Group, was founded in 1996 to develop, acquire and integrate the world’s best-in-class health care information technology capabilities. For more information, visit The Lewin Group operates with editorial independence and provides its clients with the very best expert and impartial health care and human services policy research and consulting services.

If the name Ingenix is familiar, it’s because it’s been in the news lately as the firm used by insurers like United (and others) to rip people off. From the AP:

In January, UnitedHealth agreed to pay $350 million to settle a suit by the American Medical Association and others over the issue. UnitedHealth agreed to pay $50 million toward creation of an independent claims database and eventually close down the Ingenix databases.

Rockefeller and other lawmakers say more accountability and transparency is needed in how insurance companies determine out-of-network rates.

More than 70 percent of workers are enrolled in plans that allow them to go out of network. Typically, those plans will pay a set percentage, say 70 percent, for an out-of-network visit.

But when patients go out of network, their plan doesn’t actually pay 70 percent of the cost. It pays 70 percent of what it determines is the “usual, customary and reasonable” cost.

UnitedHealth and Ingenix were allegedly manipulating claims data so the “usual, customary and reasonable” costs were too low, leaving patients to pay more. Cuomo’s office said Ingenix was understating the market rate for doctor’s visits across New York state by 10 percent to 28 percent.

Smell a rat? Me too. Richard’s quoted in Politico today commenting on The Lewin Group findings:

“The study focuses on the fact that the public health plan can save people a lot of money and depending on its design, it will have different impacts on insurers and providers,” said Richard Kirsch, national campaign manager for Health Care for America Now, which favors the public plan option.

Kirsch said physicians could see more savings than identified in the study, which did not account for lowered administrative costs associated with billing multiple insurance companies.

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