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US health insurers investigated

Senator Jay Rockefeller has written to US health insurance companies asking them to reveal the data they use to determine reimbursement and whether they intend to change their practice

Following two hearings held by the Senate Committee on Commerce, Science, and Transportation in Washington, Senator Jay Rockefeller has written to US health insurance companies asking them to reveal the data they use to determine reimbursement and whether they intend to change their practice.

At the end of March, medical societies – led by the American Medical Association (AMA ) – filed a class action lawsuit against the largest health insurance company in the US, WellPoint. Similar lawsuits have already been filed against two other insurance companies, Aetna Health and CIGNA Corporation. They allege that the insurers colluded with others to underpay for treatment if the doctor, hospital or specialist was outside the insurer's approved network. This meant that patients receiving treatment, perhaps in a medical emergency or from a specialist, had to pay an excessive contribution to the medical bill. 

The AMA claims that all three insurance companies conspired with Ingenix, part of United Health Group, to set artificially low reimbursement rates for out-of-network care. In January this year an investigation by the New York Attorney General, Andrew Cuomo, concluded that the Ingenix database is rigged to allow insurers to short change reimbursements.

Senator Rockefeller said in his closing remarks: "We are continuing this investigation because American consumers deserve to know what they're getting when they pay their health insurance premiums. They've been in the dark for too long."

7th April 2009

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