Americans pay insurance companies to make sure their medical needs are covered — and at a cost they can afford. But games, side deals and hidden incentives often result in higher costs, delays in care or denials of treatment.
New Jersey’s health plan for school employees pays out-of-network providers virtually whatever they want. Dozens of acupuncturists and physical therapists earned more than $200,000 in 2018 from school staff alone. One brought in $1 million.
Según Dignity Health, la enfermera de emergencias no cumplió con la fecha límite para agregar a su recién nacida prematura a su plan de salud, lo que la hacía responsable de las facturas médicas. La empresa rechazó las apelaciones de su empleada durante un año hasta que ProPublica se puso en contacto con ellos.
Dignity Health said its employee, an ER nurse, failed to meet the deadline to add her premature newborn to its health plan, so she was responsible for the medical bills. It rejected her appeals for a year until ProPublica called.
To protect their networks and bottom lines, health insurers don’t aggressively pursue widespread fraud, making it easy for scammers. Then they pass the costs off to you.
Experts say both employers and working Americans end up paying more when health insurance companies don’t report fraud to regulators and prosecutors.
In response to a story by ProPublica and Vox that detailed how a Texas personal trainer was able to bilk private insurers for millions, six Democratic lawmakers are asking federal regulators to take action.
Health insurers are regarded as fierce defenders of health care dollars. But the case of David Williams shows one reason America’s health care costs continue to rise. The personal trainer spent years posing as a doctor and billing the nation’s top insurers, making off with millions.
Fraud is one reason we all pay so much for health care. But there are simple fixes that would make it more difficult for scammers to operate.
A ProPublica story in February documented the hidden cash and gifts health insurers pay to influence independent brokers. In new proposed legislation, lawmakers say such fees should be revealed to employers.
The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.
Millions of sleep apnea patients rely on CPAP breathing machines to get a good night’s rest. Health insurers use a variety of tactics, including surveillance, to make patients bear the costs. Experts say it’s part of the insurance industry playbook.
CPAP units, heart monitors, blood glucose meters and lifestyle apps generate information that can be used in ways patients don’t necessarily expect. It can be sold for advertising or even shared with insurers, who may use it to deny reimbursement.
With its employee health plan in financial crisis, Montana hired a former insurance insider who pushed back against industry players with vested interests in keeping costs high. She proved, essentially, that bargaining down health care prices works.
Without any public scrutiny, insurers and data brokers are predicting your health costs based on data about things like race, marital status, how much TV you watch, whether you pay your bills on time or even buy plus-size clothing.
Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority. Just ask Michael Frank.
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