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WHY THIS SITE?
Read about the the hideous overcharges
that Cedars-Sinai Medical Center inflicted on me because I was uninsured.
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 What's happening in California?
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Insurance Companies Penalized or Under Investigation for Breaking the Law or for Bad Practices
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New created Feb 23, 2008
You reap what you sow -
Even if it is a multi-billion dollar insurance company, this universal truth still applies. Health insurers will not escape the consequences of its actions.
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AETNA
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Aetna delays change of policy on colonoscopy sedation
By GARY HABER, The News Journal / Updated Wednesday, February 27, 2008
Aetna Inc., one of the largest insurers in Delaware,
said today it will delay its plans to stop paying for the services of an anesthesiologist to sedate patients during many routine colonoscopies. One of many articles here
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CIGNA
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Health Insurer to be Charged with Teen's Murder Dec. 22, 2007
Nataline Sarkisyan, 17, died
just hours after Cigna reversed its decision and approved the procedure it had previously described as "too experimental…and unproven."
"All of the doctors there unanimously agreed
that she needed and should have that liver transplant. And the only entity, if you will, who said no to that in the middle of that medical decision, was some piece of garbage who decided that making a
couple of dollars, or saving them a couple of dollars, was worth more than the 65% chance over six months that she would survive,"...One of many articles here
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HEALTH NET
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Insurer must pay $9 million for canceling policy
Health Net dropped coverage for woman undergoing cancer treatment
SF Chronicle Staff and News Services Saturday, February 23, 2008
A Southern California woman who had her medical coverage canceled as she was undergoing treatment for breast cancer was awarded
more than $9 million Friday in a case against one of California's largest health insurers.
Patsy Bates, 52, a hairdresser from Lakewood (Los Angeles County), had been left with more than $129,000
in unpaid medical bills when Health Net Inc. canceled her policy in 2004. The insurer contended Bates failed to disclose a heart condition and lied about her weight when she applied for the policy in
July 2003.
But arbitration judge Sam Cianchetti ordered Health Net to pay her medical bills, plus $8.4 million in punitive damages and $750,000 for emotional distress.
"It's hard to
imagine a situation more trying than the one Bates has had to endure," Cianchetti wrote in his findings. "The rug was pulled out from underneath, and that occurred at a time when she is
diagnosed with breast cancer, one of the leading causes of death for women."
One of many articles here
Los Angeles City Attorney Sues Health Net, Alleging Scheme to Cancel Policies
"This practice of post-claims policy cancelation is unlawful, unfair and fraudulent," said City
Attorney Delgadillo. Health Net went so far as to create a secret unit to cancel policies when patients needed expensive medical treatment. Health Net Inc. saved about $35 million by illegally
canceling the coverage of at least 1,600 patients over four years, the city attorney's office alleges in the lawsuit filed Wednesday. "Health Net provided benchmarks and economic incentives to the
individual responsible for these illegal cancelations, should she reach the company's goals," City Attorney Rocky Delgadillo said in an interview. One of many articles here Read the actual Court Complaint here
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PACIFICARE/UNITED HEALTH
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UnitedHealth facing up to $1.3 billion in fines for alleged payment problems
By Barbara Feder Ostrov / Mercury News / Article Launched: 01/29/2008
UnitedHealth,
the nation's largest health insurer, faces penalties of up to $1.3 billion from California regulators for alleged payment problems that caused chaos for both doctors and patients. <SNIP>
The
Department of Managed Healthcare, which oversees Pacificare/United's HMO business, also fined the insurer $3.5 million for its mishandling of managed care claims. <SNIP>
A joint investigation by the two agencies found that Pacificare, which merged with United Health in 2005, failed to pay claims in a timely manner, wrongly denied claims, incorrectly paid claims, lost
patients' records, mishandled provider networks and failed to respond quickly to complaints. The investigation uncovered 130,000 alleged violations of state law." One of many articles here
PacifiCare's alleged violations cited by CDI and DMHC include:
* Wrongful denials of covered claims
* Incorrect payment of claims
* Lost documents including certificates of creditable coverage and medical records
* Failure to timely acknowledge receipt of claims
* Multiple requests for documentation that was previously provided
* Failure to address all issues and respond timely to member appeals and provider disputes
* Failure to manage provider network contracts and resolve provider disputes
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UNITED HEALTH GROUP'S DATABASE CO. "INGENIX"
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CUOMO ANNOUNCES INDUSTRY-WIDE INVESTIGATION INTO HEALTH INSURERS' FRAUDULENT REIMBURSEMENT SCHEME
Database Company Ingenix – Used by Dozens of Insurers – at Center of Scheme
Cuomo Notifies Ingenix and its Parent, UnitedHealth Group, of Intent to File Suit; Subpoenas 16 Other Companies
NEW YORK, NY (February 13, 2008) – Attorney General Andrew M. Cuomo today
announced that he is conducting an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates.
At the center of the scheme is Ingenix, Inc., the nation's largest provider of healthcare billing information, which serves as a conduit for rigged data to the largest insurers in the country.
Cuomo also announced that he has issued 16 subpoenas to the nation's largest health insurance companies including Aetna (NYSE: AET), CIGNA (NYSE: CI), and Empire BlueCross BlueShield (NYSE:
WLP), and that he intends to file suit against Ingenix, Inc, its parent UnitedHealth Group (NYSE: UNH), and three additional subsidiaries.
The six-month investigation found that Ingenix
operates a defective and manipulated database that most major health insurance companies use to set reimbursement rates for out-of-network medical expenses. Further, the investigation found that two
subsidiaries of United (the "United insurers") dramatically under-reimbursed their members for out-of-network medical expenses by using data provided by Ingenix.
Official press release here
Detailed article here
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