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Why Health Care Is So Expensive
United Health Group

The reason for my continuance on American health care is due to the importance of a healthy society be it American, Nigerian or Russian. To me, it does not matter. I'm just continuing to give you facts and figures for you to see what is really going on in case you have forgotten. The following is from an article dated Oct. 20, 2006. That is almost 4 years ago.

"Insurance premiums have risen by 73.8% from 2000 to 2006, while the U.S. median income has increased 11.6% during that same period", according to a study released Tuesday by Families USA.

And this from The Huffington Post Mar 12, 2010.

 "Proposed premium increases of as much as 39 percent by WellPoint's Anthem Blue Cross in California set off a wave of criticism and forced the company last week to announce a postponement. President Barack Obama seized on Anthem as Exhibit A to make his case for sweeping change before a bipartisan White House health summit next week. California officials said more than 700,000 households face increases averaging 25 percent overall and as high as 39 percent for some. In a briefing for reporters, WellPoint executives blamed their rate increases on rising medical costs and a pool of customers that is gradually becoming older and sicker, as younger, healthier people drop coverage. They insisted that their competitors are raising rates in much the same way. "We understand this is a hardship," said Brian Sassi, president and CEO of WellPoint's consumer-business unit. "This is not something that voluntarily we choose to do." ( Who are these guys kidding? ) Michigan's Blue Cross Blue Shield plan requested approval for premium increases of 56 percent in 2009. And in the state of Washington, rates for some individual health plans increased by up to 40 percent until regulators cracked down. Other states cited in the report were Connecticut, Oregon and Rhode Island.

Did you know this? Consumers and medical providers may be entitled to millions of dollars in reimbursements from the hundreds of insurers who used Ingenix to reduce medical expense claims. However, the Ingenix problem is just the tip of a big iceberg. Insurance companies have an entire arsenal of cost containment tactics designed to reduce your bills: Silent PPOs, Prompt-Pay violations, UCR reductions, improper contract interpretation, retroactive denials, outdated fee schedules, and other forms of managed care contract abuse. It is so prevalent that it has been given a name - "Managed Care Contract Abuse". The major culprit? Ingenix. Who or what is Ingenix? Keep reading.

Headquartered in Minnetonka, Minnesota, UnitedHealth Group offers a broad spectrum of products and services through seven operating businesses: UnitedHealthcare, Ovations, AmeriChoice, Uniprise, OptumHealth, Ingenix, and Prescription Solutions. Through its family of subsidiaries and divisions, UnitedHealth Group serves approximately 70 million individuals nationwide. In 2008, the company posted a net income of $3 billion. UnitedHealth Group is the parent of UnitedHealthcare, one of the largest health insurers in the U.S.

Now to the meat of this company. In a recent non-insurance industry survey of health care executives who have dealt with the company, United received a 91% unfavorable rating—the worst ranking among all listed. In 2006, the Securities and Exchange Commission (SEC) began investigating the conduct of UnitedHealth Group's management and directors, for backdating of stock options. Investigations were also begun by the Internal Revenue Service and prosecutors in the U.S. attorney's office for the Southern District of New York, who subpoenaed documents from the company. In February 2008, New York State Attorney General Andrew M. Cuomo announced an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reasonable and customary rates. The announcement included a statement that Cuomo intended "to file suit against Ingenix, Inc., its parent UnitedHealth Group, and three additional subsidiaries. On January 13, 2009, UnitedHealth Group and Ingenix announced an agreement with the New York State attorney settling the probe into the independence of the health pricing database. Under the settlement, UnitedHealth Group and Ingenix would pay $50 million to finance a new, non-profit entity that would develop a new health care pricing database.

On October 27, 2009, Cuomo announced the creation FAIR Health, the independent, non-profit organization that will develop a nationwide database for consumer reimbursement, as well as a website where consumers will be able to compare prices before they choose doctors. To fund FAIR Health, the Attorney General's office secured nearly $100 million from insurers such as Aetna Inc, UnitedHealth Group Inc and WellPoint Inc.

Let's go back to 2006 for just a moment to the then CEO, William McGuire, MD and his compensation. Former UnitedHealth Group CEO William McGuire, agreed to $468 million in penalties to settle a Securities and Exchange Commission investigation into improper stock-option backdating. About $448 million of that total consisted of options Dr. McGuire agreed to forfeit, on top of $200 million in options he forfeited in 2006. ( Wow. Hello, patients premiums! Are you still there? )

Here are a few more tid bits for your perusal. And don't forget, these are the frauds who create "your" artificial premiums.

This is how New York Attorney General Andrew Cuomo described UnitedHealth Group's Ingenix business, whose database is used by the country's largest health plans to set out-of-network pay rates. Cuomo and his investigators outlined why the Ingenix data are flawed. United says it has done nothing wrong. ( Lest my heart be still. )

"The Ingenix database lacks information about the provider's training and qualifications, the type of facility where the comparative service was provided, and the patient's condition."

"Ingenix manipulates the database by deleting valid high charges and deleting proportionally more high charges than low charges."

"Ingenix deletes from the database charges that have modifiers to indicate procedures or services with complications. The charges are typically higher."

"Ingenix fails to collect information affecting the value of the service, such as whether the service was performed by someone other than a physician."

"Ingenix pools data from dissimilar providers (such as nurses, physician assistants and physicians) for use in the Ingenix database."

"The Ingenix database contains outdated information."

"Ingenix fails to audit the data it receives from data contributors to ensure that they have submitted all appropriate data and have not included negotiated or discounted rates."

"Some data contributors delete higher charges from the data they submit to the Ingenix database, thereby skewing reimbursement rates downward."

"Ingenix uses the defective data in the database, and a deficient methodology, to 'derive' additional charges. The use of defective data to formulate a rate for other charges means that the resulting rate itself is defective."Source: New York Attorney General Andrew Cuomo's office.)

America. My goodness. Please wake up! This is why your premiums are always going to skyrocket. You will never know if you are covered. It will always be at the private health care corporations whim deciding what you are covered for and what not. You have paid into your premiums for the past 42 years and now you have a health problem. You are denied coverage because you had a pre-condition when you were thirteen years of age. The pre-condition? Acne. Sorry. Tough luck on your part. And you call this health care coverage? And you are listening to these corporation millionaires at your expense and beleiving them? No wonder the rest of the world is shaking our heads at the lack of American understanding. And just like Sarah Palin, you will be sneeking across the border to Canada for proper health care and yes if you can't afford it, or even if you can, you won't have to pay a penny. Now that's health care. Period.