Insurers Colluded to Underpay Doctors, Now Targeting Children

A Win for Doctors
A federal judge approved a $350 million class action settlement with UnitedHealth Group, awarding an additional $89 million in attorney fees and expenses.

The settlement in The American Medical Association v. United Healthcare Corporation resolves claims that UnitedHealth colluded with others to underpay doctors outside of its network. reports that the suit was filed in 2000 by the American Medical Association, along with other medical groups, providers, and patients who were harmed by UnitedHealth’s use of a database to determine payments to out-of-network providers.

In 2009, UnitedHealth agreed to a $50 million settlement and closure of the database after an investigation by New York Attorney General Andrew Cuomo. Two days later, the class action was filed, requiring the end of the database on a national basis.

Critics of health care reform and The Affordable Care Act often point to concern for doctor payment when the bill is fully enacted. It seems insurers were already doing all they could to cut into physician payments.

A Loss for Children
With a key component of The Affordable Care Act coming into play this week, insurers are targeting another group — children. The new law requires insurers to accept applications from sick children — but doesn’t require them to sell policies to children at all.

An article on Wall Street Journal online reports that Aetna Inc., Cigna Corp., WellPoint Inc., Humana Inc., and UnitedHealth Group Inc’s Golden Rule subsidiary will no longer sell new child-only policies, thereby forcing parents to apply for coverage for their children on their own plans. That’s assuming they have plans for themselves.

This is exactly what insurers said they would not do.

WSJ quotes Nancy Pelosi as saying, “Earlier this year, the companies pledged to cover children with pre-existing conditions — in keeping with the spirit of reform that requires they no longer drop coverage for these children. Now, some companies are backtracking on writing new policies, potentially leaving many children without the health insurance they desperately need.”

From the Health Care For America blog:

“This offensive behavior by the insurance companies is yet another reminder of why the new law is so important and why the Republican call for repeal is so misguided. For too many years, it’s been the insurance companies against us, and they win. With the new consumer protections, we can start winning for a change – and get the health care we pay for and need.

If the insurance companies are so willing to turn their backs on sick children now, who will they abandon next?”

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Grace A.
Grace Adams7 years ago

Of course. Insurance companies are the direct descendants of riverboat gamblers. Of course the are going to do their best to avoid taking on a wager they are likely to lose. Of course the vast majority of American businesses put a lot of effort into gaming the system. They have to to survive. Americans use money as counters to keep score in the game of life. Money is the only thing that gets much respect in the USA, and then only in substantial quantities.

jane richmond
jane richmond7 years ago

Is anyone REALLY surprised by this? Money is the bottom line and the only thing that counts for insurers.

Quanta Kiran
Quanta Kiran7 years ago

all medical schemes are full of crap!

Melannie B.
Melannie B7 years ago

There is much between being a altruist and being a for profit business. It's not an binary of either this or that. Most businesses could still operate with fair practices and make a decent profit but they don't want that. Insurance companies want to break a lot of rules, some legal, most ethical, to insure big profits for themselves and undercut everyone else. This used to be not allowed, called thievery or usury, and lying was called just that, and also disallowed, but now it's all acceptable because it's business and some small group of privileged people have decided business can do whatever they want. But it can't, nor should it be allowed to.It's led to this and it's time say no more. Because it's about being decent and fair to all, for all. That's democracy. And it's time to get back to being that.

Mike Masley
Michael Masley7 years ago

We need to really take a look at these companies and decide that they are not American patriots, could care less about the future of this country - and give them the boot!

Kay L.
KayL NOFORWARDS7 years ago

Why do so many Americans seem to think that insurance companies should be altruists? They are businesses and can't exist if they don't make a profit. If you want non-profit insurance, you need to go the government route, like Canada, Great Britain, etc....

Roger C.
Roger C7 years ago

As abhorrent as these actions are, let's not assign human emotions to insurance companies. Corporations exist for one goal--to make money for their stockholders. Feeling guilt & compassion don't contribute to profit. It is the 'for-profit' insurance model, which is the culprit. We need the public option, or even better, single payer, but Obama can't do it by himself. If Congress passed it--he'd sign it.

Lionel Mann
Lionel Mann7 years ago

There is no depth to which insurance companies will not sink in order to exploit the general public. A bettter recommendation for the institution of a national health-care system would be hard to find.
How long will it take for the general poublic of the U.S.A. to come to its senses and to realise that it is anything other than a democracy but is being robbed blind by the vicious, voracious, vultures of Manhattan who have complete control of government, judiciary and economics? Anybody who votes Republican in November is tightening the noose around his/her neck.

Marilyn L.
Marilyn L7 years ago

No surprise.

Ronald Ellsworth
Ronald E7 years ago

There is no bright side to the health insurance industry but at least they are not routinely denying payment for services specifically covered in your policy like they used to do. They knew if they bounced the claim 3-4 times the policy holder might just give up or not have the time to repeatedly file the claim. Score one for the consumer. Hundreds more to go.