Health Insurance Hustle
The Confounding Way We Pay for Care
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.
What Happens When a Health Plan Has No Limits? An Acupuncturist Earns $677 a Session.
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.
Un hospital cobra a una de sus enfermeras casi $900,000 tras dar a luz a una bebé prematura
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.
How One Employer Stuck a New Mom With an $898,984 Bill for Her Premature Baby
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.
We Asked Prosecutors if Health Insurance Companies Care About Fraud. They Laughed at Us.
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.
How to Make Health Insurers Take Fraud Seriously
Experts say both employers and working Americans end up paying more when health insurance companies don’t report fraud to regulators and prosecutors.
Senators Call for Closing “Loopholes” That Make Health Care Fraud Easy
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 Make It Easy for Scammers to Steal Millions. Who Pays? You.
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.
What Can Be Done Right Now to Stop a Basic Source of Health Care Fraud
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.
Senators Call for Disclosure of Perks and Fees Paid to Health Benefits Brokers
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.
Behind the Scenes, Health Insurers Use Cash and Gifts to Sway Which Benefits Employers Choose
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.
You Snooze, You Lose: Insurers Make The Old Adage Literally True
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.
Your Medical Devices Are Not Keeping Your Health Data to Themselves
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.
In Montana, a Tough Negotiator Proved Employers Don’t Have to Pay So Much for Health Care
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.
Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates
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.
Why Your Health Insurer Doesn’t Care About Your Big Bills
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.
Do You Work in the Health Insurance Field? ProPublica Is Investigating the Industry and We’d Like Your Help
We need your perspective on the health insurance hustle.
