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AMA Commends N.Y. Investigation of Health Insurers
Date:2/13/2008

Patients who challenge the costs assigned by the insurer are met with a brick wall of secrecy. This effort to conceal the payment process ensures that patients and physicians don't have the necessary information to hold UnitedHealth accountable to its payment obligations.

"Despite repeated requests from patients and physicians, UnitedHealth Group has refused to specify how UCR amounts are determined. We believe UnitedHealth's UCR calculations can't withstand close scrutiny because they rely on flawed data and invalid statistical methods.

"In an era of increasing health care transparency, it is shocking and unacceptable for a health insurer to profit from deliberately withholding information from patients and physicians. The shroud of secrecy covering UnitedHealth's entire payment process must be lifted. There is no legitimate policy rationale behind the health insurer's refusal to provide information to physicians and patients. It serves only as a means for health plans to increase profits by keeping patients and physicians in the dark.

"This is one more example of UnitedHealth playing by its own rules without regard to state laws designed to protect patients and physicians. UnitedHealth has developed a track record of regulatory violations stretching from Monterey to Montauk.

"The state of California is seeking up to $1.3 billion in fines from UnitedHealth for more than 130,000 violations of state law. New York state officials took the unprecedented step of banning UnitedHealth from enrolling any new HMO customers in 2006 after the insurer repeatedly defied state regulations.

"The AMA greatly appreciates the Attorney General's interest and leadership in protecting consumers, and we offer our full cooperation in any effort to hold UnitedHealth accountable to New York state laws."


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SOURCE American Medical Association
Copyright©2008 PR Newswire.
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