United Healthcare to Hospitals – Notify Within 24 Hours of Patient Admittance or Reimbursement Will Be Cut in Half
Posted Jan 25 2010 11:24am
As the CEO of United has stated “Our shareholders will prosper” and this appears to be a pretty stiff penalty as clerical errors will and do arise. Already we have the never-never events for hospitals to work with which are designed around more safety items than anything else. Why do they want this information, so they can start earlier on projecting what your “illness” algorithmic score is going to be, in other words what’s all of this going to cost.
The hospital group has already sent letters advising patients to shop around for another carrier to 85,000 insured. If the consumer gets a plan through their employer where they can’t change, well what do they do? I would guess the employer needs to do some shopping. Let’s not forget the record profits the company just posted for the 4th quarter here too.
United is inter-tangled in so many areas of healthcare aside from just providing health insurance too through their wholly owned subsidiaries. They have a lot of data base information that they sell, for example they even sell data to clinical trial companies.
They partnered with Cisco to invest hundred of millions for a telehealth network, which is not necessarily a bad thing, but bottom line is this money does not go towards paying claims directly and the idea of being financed by an insurance company when perhaps more government intervention here could be a plus is a question posed from me as all insurers should take advantage of telehealth without one calling the shots.
The company is also busy in assuming former HealthNet insured in the northeast section of the US, again fewer choices for consumers to select from in that area.
In 2009, they helped fund the “tea parties”.
We have the data base that was used for years not only by United, but by other insurers too that used and paid for this service to calculate “out of network” charges for consumers and doctors, and lawsuits are many in this area, so they will need funds to cover this expense too.
Interesting enough on the outcome here, a “non profit” now will take over and create a data base for insurers to use for calculations that was run by Ingenix, health insurers should be a non profit entity anyway as the layer of trust and the way they do business is at terrible fault, it’s all over the news.
This data base existed for years and it was not until the middle of last year that even HealthNet decided to no longer use it for their calculations, so other insurers paid United for it’s use.
The company has purchased other competitors in the same business.
Some consumers now are having to battle Ingenix directly themselves and car insurance legal cases are also involved here with legal suits stating they paid less than the contract called for.
And yet, we continue to give United directly or indirectly additional revenue to prevent “fraud”, pot calling the kettle black here? The state of Washington is using their services to help score and use algorithmic formulas to help prevent fraud.
They also make money selling our medication information to other insurers or entities, this has gone on for years in conjunction with pharmacy benefit managers. If you are trying to get qualified to be underwritten by a company outside of United, there’s a good chance they get a cut here with providing your medication records, and there are a couple others who do this as well, but they have a big stand in this business. In providing medications, Medco with their services on providing mail order automated meds had profits of close to 15 Billion in the 3rd quarter of 2009 so there’s good reason to stay connected monetarily to the pharmacy benefit managers too to get the data and re sell our medication records.
After reading some of the information above, you may wonder:
I just wanted to point out some of the other areas in which United operates if you were not aware, more than just providing health insurance and entrenched in many related businesses. Congress has even asked the CEO how he can sleep at night during Senate hearings last year.
In order to abide by the 24 hour rule, this almost dead on requires electronic transmission to cover weekends for sure if an admittance takes place and in addition the article states that a 7-10 cut is also included here, so the insurance/technology folks are out to play hardball, as they want the data, in God we trust, all others must bring data. Other carriers have rules but most said they are rarely enforced, but the contract supplies the words though that could allow this to happen at any time the idea of enforcement comes into play.
How would you feel as a patient to find out due to an administrative over site that your coverage for a procedure has been dropped to half, even though you have read your policy and received approval for a procedure? No wonder the hospitals are telling patients to steer clear to help avoid this consequence. Now you have the insurance company algorithmic formulas for payments to battle, but also the hospital to inquire as to what happened here, and this placed the hospital and patients in a very unfavorable position, creating a new battle ground that has not existed in this format before. If you read further you can see that state governments had to jump in here with laws to negate such clauses, so the circle continues to go around as the result of health insurance carriers being on the stock market for profit. BD
A front in the national health care battle has opened in New York City, where a major hospital chain and one of the nation’s largest insurance companies are locked in a struggle over control of treatment and costs that could have broad ramifications for millions of people with private health insurance.
UnitedHealthcare is negotiating or imposing similar rules at hospitals across the country, and often meeting fierce opposition. Tennessee passed a law saying the penalty would not apply on weekends or federal holidays, when hospitals are short-staffed. Florida hospital officials said that the new rule could play a role in coming contract negotiations there, and that the state hospital association had asked Florida’s insurance regulators to monitor the situation.