When patients go out of their health plan network, their plan is supposed to pay 70 percent of the doctor’s visit cost. It appears that insurance companies pay 70 percent of what it determines is the “usual, customary and reasonable” cost for the procedure or doctor’s visit in question. Insurance companies determine that cost themselves, and there’s no proper oversight of how they do it.

United Health Group is in hot water in this issue. It was allegedly manipulating claims data so that the “usual, customary and reasonable” costs they used were lower than they should have been, leaving patients to pay more. Sen. Jay Rockefeller, chairman of the Senate Commerce, Science and Transportation Committee and New York Attorney General Andrew Cuomo are on the case.

I wonder how long these insurance companies were cheating the patients if the charges are true.

Source: Senators examining insurance companies’ out-of-network practices