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This is one of those jaw dropping health insurance stories for sure.  There's a few interesting characters in this one.  

In New York as well as several other states we have seen United Healthcare dropping doctors from their networks, and court cases are coming out and this has to do with senior care.  

At the same time, however, let's take a look at a doctor, who has some celebrity clients and I'm not picking apart what they pay and negotiate, but just rather what happens when a normal consumer with insurance visits.

With all the scrutiny with payment of claims you jaw will hit the floor when you see an insurance carrier have no problem paying $175k for a hammer to procedure that should be billed even a high rate not more than 25k and it could be a lot less.  

$175,098.80 To Fix A Hammer Toe Billed by New York Podiatrist And the Insurer Paid It, Well Sort Of As They Sent the Check to the Patient By Accident, A New Investigation For “Out of Network” Charges Has Resulted

The banker's wife who had this done even got mad.  I would guess there's a lot more of this going on that we see.  By the way it's worth it to think about all the subsidiary companies owned by insurers and this one has 15 pages listed at the SEC and 1/3 of their revenue comes from technology ventures which leaves 2/3 of their revenue with selling policies.  

I think it's worth the mention as others are doing the same with acquisitions and when you look at what a health insurance company is today, see what other businesses they are in, i.e hospice for profit with United for one example of a subsidiary company as well as owning a bank, cheap hearing aides, investing in low income housing, various types of consulting services, medical records, and it goes on and on to even fixing Healthcare.Gov.  

Health Insurance Business Under the radar With Tiered Subsidiaries–Where All the Action Takes Place With Mergers, Acquisitions and Profit Centers-Subsidiary Watch

So is this one a story and a half?  So far they have been incredibly quiet about it a well.  So one has to wonder if there's "tiered" insurance out there too.  The only reason this story made it out there was due to the fact that they charge was so outrageous that even the banker complained.  

An Update more link to check out as pretty soon you may end up in a United Healthcare Urgent care clinic...they are in that business too and have opened a take a second look if you will at the big picture with insurers..

United Healthcare Now Entering the Urgent Care Clinic Business To Help Keep Patients Out of the ER, Two More Opening In Houston–Subsidiary Watch

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Comment Preferences

  •  Tip Jar (4+ / 0-)

    The Medical Quack

    by medicalquack on Tue Apr 01, 2014 at 07:28:35 AM PDT

  •  The health insurance industry is as crooked (2+ / 0-)
    Recommended by:
    Skyye, allie4fairness

    As a dog's hind leg.

    I can't help but wonder how long before people aren't so enamored with mandated health insurance and we finally push towards fixing the system properly.

    "It's not surveillance, it's data collection to keep you safe"

    by blackhand on Tue Apr 01, 2014 at 08:10:51 AM PDT

  •  This is jarring to read, and the point is (2+ / 0-)
    Recommended by:
    SlightKC, worldlotus

    thereby obscured.  A more rigorous editing process seems appropriate.

    •  Yep. Clicking through to some of the links proved (0+ / 0-)

      to be the same.  

      However, one of the links within the links gave me some possible insight as to why my current insurance company is not on the federal exchange for my state.

      This possible insight alleviates some of the confusion on my end as to why.  

      Bummer because I have top tier coverage that will end when COBRA expires & the insurance carrier is not listed on the exchange-yet still provides health insurance coverage for businesses in my state.

      Hopefully we will find comparable when the time comes as we really need an array of good medical benefits due to sudden health issues......

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