AMA joins lawsuit against Wellpoint
It has been recently announced that the AMA is among several medical societies filing a class action lawsuit against WellPoint, Inc. This is an expansion of efforts to expose and prohibit an industry-wide health insurance scheme to defraud patients and physicians of proper reimbursement.
The lawsuit, filed in Los Angeles federal court, alleges WellPoint colluded with others to underpay physicians for out-of-network medical services, resulting in patients paying an excessive portion of the medical bill. The AMA filed similar class action suits against Aetna Health, Inc. and CIGNA.
This has been a conspiracy by the insurance companies for far too long and the AMA and others have recognized it and are challenging it in court.
The three AMA lawsuits claim each insurer conspired with Ingenix, a unit of United Health Group, on a price-fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care. An investigation by the New York attorney general confirmed the Ingenix database is intentionally rigged to allow insurers to shortchange reimbursements.
A spokesman stated; “Now that the underlying scheme has been exposed, health insurers are doing the right thing by cutting their ties with the flawed Ingenix database. However, serious damages resulting from prior use of the Ingenix database still need to be addressed.”
The AMA and partnered medical societies seek reforms for the invalid payment system and relief for physicians harmed by long-term use of Ingenix.
This WellPoint lawsuit is supported by AMA and State Medical Societies including the California Medical Association, Connecticut State Medical Society, Medical Association of Georgia and North Carolina Medical Society.
The lawsuit, filed in Los Angeles federal court, alleges WellPoint colluded with others to underpay physicians for out-of-network medical services, resulting in patients paying an excessive portion of the medical bill. The AMA filed similar class action suits against Aetna Health, Inc. and CIGNA.
This has been a conspiracy by the insurance companies for far too long and the AMA and others have recognized it and are challenging it in court.
The three AMA lawsuits claim each insurer conspired with Ingenix, a unit of United Health Group, on a price-fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care. An investigation by the New York attorney general confirmed the Ingenix database is intentionally rigged to allow insurers to shortchange reimbursements.
A spokesman stated; “Now that the underlying scheme has been exposed, health insurers are doing the right thing by cutting their ties with the flawed Ingenix database. However, serious damages resulting from prior use of the Ingenix database still need to be addressed.”
The AMA and partnered medical societies seek reforms for the invalid payment system and relief for physicians harmed by long-term use of Ingenix.
This WellPoint lawsuit is supported by AMA and State Medical Societies including the California Medical Association, Connecticut State Medical Society, Medical Association of Georgia and North Carolina Medical Society.
posted by Anonymous at 5:42 AM
4 Comments:
I think this is wonderful. For too long, the health insurance industry has run wild and treated doctors (and their insured policyholders - like me) very unfairly. Just look at the present situation in Louisville between the Norton medical providers and Anthem as an example. Its truly ridiculous.
I think this case has great merit, and I hope the physicians wax Wellpoint. A large legal victory would be one small step in the health care reform we've needed for too long if the result discourages the major health insurers from this harmful conduct. Wellpoint's payment of multi-million dollar annual bonuses to their corporate execs while shortchanging physicians on reimbursement rates and gouging their insureds has been a disgrace for too many years.
However, I do have to note that its interesting that physicians have no trouble invoking the legal system to protect their own rights and to address their own percieved harms & injuries, yet continuously advocate for malpractice laws to limit the rights of injured patients. Just a little ironic, in my mind.
Anyhow - I wish the AMA well in their endeavor!
I am not opposed to lawsuits. I just wish they weren't as easy to initiate and I wish those instigating them had some financial disincentive if they lose.
I feel this way in regards to medical as well as other lawsuits. There are times when legitimate suits need to occur and individuals and corporations need to be held accountable.
Go to ANY hospital, stay for a day or two, with or without insurance. $10 for a 50 cent furosemide.$9.75 for an acetamenophen tablet. Or even better yet, $20..00 for water based lubricant application.
Lets not overlook over $400 per night JUST for a regular bed. a thousand dollars for a 2 minute in room "consultation" by a doctor. The entire healthcare industry is gold digging end users for everything they can. Overcharging for dirt cheap medications, in some cases more than a 500% mark up. The doctors getting mad because they are not getting "reimbursed" at the rate THEY want to see, then passing the difference on to patients, or the nurses, medical assistants, lab techs, pharmacy techs, orderlies all BARELY making a living, doing the work the patients need to recover.
Physician, Heal Thyself
anonymous,
Medicare reimbursement for a daily hospital visit for physicians is as follows:
99231 (low level visit)is $36.00
99232 is $64.90
99233 (Med level visit)is $92.96
99235 (Intensive care)is $161.54
This includes reviewing all the labs, xrays, ekg's, nurses notes, respiratory therapy notes and other physicians notes, making treatment decisions, writing orders and documenting progress notes.
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