{"id":3653,"date":"2024-04-07T07:00:30","date_gmt":"2024-04-07T07:00:30","guid":{"rendered":"https:\/\/medexperts.pro\/?p=3653"},"modified":"2024-04-07T07:28:34","modified_gmt":"2024-04-07T07:28:34","slug":"insurance-companies-reap-hidden-fees-as-patients-get-unexpected-bills","status":"publish","type":"post","link":"https:\/\/medexperts.pro\/?p=3653","title":{"rendered":"Insurance Companies Reap Hidden Fees as Patients Get Unexpected Bills"},"content":{"rendered":"
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A little-known data firm helps health insurers make more when less of an out-of-network claim gets paid. Patients can be on the hook for the difference.<\/p>\n

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Weeks after undergoing heart surgery, Gail Lawson found herself back in an operating room. Her incision wasn\u2019t healing, and an infection was spreading.<\/p>\n

At a hospital in Ridgewood, N.J., Dr. Sidney Rabinowitz performed a complex, hourslong procedure to repair tissue and close the wound. While recuperating, Ms. Lawson phoned the doctor\u2019s office in a panic. He returned the call himself and squeezed her in for an appointment the next day.<\/p>\n

\u201cHe was just so good with me, so patient, so kind,\u201d she said.<\/p>\n<\/div>\n<\/div>\n

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But the doctor was not in her insurance plan\u2019s network of providers, leaving his bill open to negotiation by her insurer. Once back on her feet, Ms. Lawson received a letter from the insurer, UnitedHealthcare, advising that Dr. Rabinowitz would be paid $5,449.27 \u2014 a small fraction of what he had billed the insurance company. That left Ms. Lawson with a bill of more than $100,000.<\/p>\n

\u201cI\u2019m thinking to myself, \u2018But this is why I had insurance,\u2019\u201d said Ms. Lawson, who is fighting UnitedHealthcare over the balance. \u201cThey take out, what, $300 or $400 a month? Well, why aren\u2019t you people paying these bills?\u201d<\/p>\n<\/div>\n<\/div>\n

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Gail Lawson faced more than $100,000 in bills after a complex surgery. Her insurance paid out $5,449.27.<\/span>Bryan Anselm for The New York Times<\/span><\/span><\/span><\/figcaption><\/figure>\n<\/div>\n<\/div>\n
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How MultiPlan and Insurers Make Money on Fees<\/h3>\n

MultiPlan and health insurers typically receive a percentage of the \u201csavings\u201d on each claim, creating an incentive to recommend lower payments.<\/p>\n<\/p><\/div>\n<\/div><\/div>\n

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Fee percentages vary based on negotiated contracts.<\/p>\n

By The New York Times<\/p>\n<\/p><\/div>\n<\/div><\/div>\n<\/figure><\/div>\n<\/div>\n<\/section>\n<\/div>\n

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Confidential Pricing and Fee Data<\/h3>\n

Itemized payments and fees for thousands of claims were made public in a lawsuit against Cigna after The Times petitioned the court. The insurer and MultiPlan opposed the release, calling the data \u201chighly confidential.\u201d<\/p>\n<\/p><\/div>\n<\/div><\/div>\n

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View the PDF<\/a>.<\/p>\n

By The New York Times<\/p>\n<\/p><\/div>\n<\/div><\/div>\n<\/figure><\/div>\n<\/div>\n<\/section>\n<\/div>\n

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Fact Check: An Explanation of Benefits<\/h3>\n

Insurance statements often identify savings or discounts. But sometimes patients can still be billed for that amount, as in this case involving the UnitedHealth subsidiary UMR.<\/p>\n<\/p><\/div>\n<\/div><\/div>\n

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View the PDF<\/a>.<\/p>\n

By The New York Times<\/p>\n<\/p><\/div>\n<\/div><\/div>\n<\/figure><\/div>\n<\/div>\n<\/section>\n<\/div>\n

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Want all of The Times?\u00a0Subscribe<\/a>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n","protected":false},"excerpt":{"rendered":"

A little-known data firm helps health insurers make more when less of an out-of-network claim gets paid. Patients can be on the hook for the difference.Weeks after undergoing heart surgery, Gail Lawson found herself back in an operating room. Her incision wasn\u2019t healing, and an infection was spreading.At a hospital in Ridgewood, N.J., Dr. Sidney Rabinowitz performed a complex, hourslong procedure to repair tissue and close the wound. While recuperating, Ms. Lawson phoned the doctor\u2019s office in a panic. He returned the call himself and squeezed her in for an appointment the next day.\u201cHe was just so good with me, so patient, so kind,\u201d she said.But the doctor was not in her insurance plan\u2019s network of providers, leaving his bill open to negotiation by her insurer. Once back on her feet, Ms. Lawson received a letter from the insurer, UnitedHealthcare, advising that Dr. Rabinowitz would be paid $5,449.27 \u2014 a small fraction of what he had billed the insurance company. That left Ms. Lawson with a bill of more than $100,000.\u201cI\u2019m thinking to myself, \u2018But this is why I had insurance,\u2019\u201d said Ms. Lawson, who is fighting UnitedHealthcare over the balance. \u201cThey take out, what, $300 or $400 a month? Well, why aren\u2019t you people paying these bills?\u201dGail Lawson faced more than $100,000 in bills after a complex surgery. Her insurance paid out $5,449.27.Bryan Anselm for The New York Times<\/p>\n","protected":false},"author":1,"featured_media":3655,"comment_status":"close","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33],"tags":[],"class_list":["post-3653","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health"],"_links":{"self":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts\/3653","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3653"}],"version-history":[{"count":2,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts\/3653\/revisions"}],"predecessor-version":[{"id":3656,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts\/3653\/revisions\/3656"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/media\/3655"}],"wp:attachment":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3653"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3653"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3653"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}