UH Sues American Renal Associates

[dgoldenz]

Interesting, curious to see what comes of this...also of note that the government pays $300/session for dialysis and UH pays $4,000/session, but what else is new?

UnitedHealth Sues American Renal Associates, Alleging Fraud - WSJ

 

[kgmom219]

Interesting, curious to see what comes of this...also of note that the government pays $300/session for dialysis and UH pays $4,000/session, but what else is new?

UnitedHealth Sues American Renal Associates, Alleging Fraud - WSJ

UHC isn't PAYING the $4K. That's what is being billed. When's the last time a provider paid the billed amount?

ESRD is an issue in itself. They need to change the law, but its getting to the point that so many people are employed due the ESRD coverage that they can't do anything about it.

It's going to get thrown out, BTW. Providers sending people to the Exchange and saying "X Carrier has the best coverage for your condition" isn't illegal. It may be unethical, but UHC going after someone for unethical behavior is a farce.

 

[dgoldenz]

UHC isn't PAYING the $4K. That's what is being billed. When's the last time a provider paid the billed amount?

ESRD is an issue in itself. They need to change the law, but its getting to the point that so many people are employed due the ESRD coverage that they can't do anything about it.

It's going to get thrown out, BTW. Providers sending people to the Exchange and saying "X Carrier has the best coverage for your condition" isn't illegal. It may be unethical, but UHC going after someone for unethical behavior is a farce.

The suit said American Renal Associates’ reimbursement from government programs was $300 or less per dialysis session, but it sought to bill UnitedHealth around $4,000 a session

I don't know what dialysis costs are, but it sounds to me like their are billing $4k as the negotiated rate.

Seems like the easy thing for the insurance company to do would be to terminate their contract with the providers...and FWIW I think they definitely have a case. They probably also have a lot more high-priced lawyers than ARA does.

 

[kgmom219]

I don't know what dialysis costs are, but it sounds to me like their are billing $4k as the negotiated rate.

Seems like the easy thing for the insurance company to do would be to terminate their contract with the providers...and FWIW I think they definitely have a case. They probably also have a lot more high-priced lawyers than ARA does.

Of COURSE they have better lawyers, their profit last year was more than a Billion (with a capital B)

I don't think they have a case and that this will set a dangerous precedent for providers. What happens if UHC wins and you call your doc and say "who is the best company when I am picking my plan?". "Sorry, I am not allowed to help you with that."

And with all the calls for more rate transparency, this goes against that issue, too.

My two cents. I could be totally wrong. Happens all the time.....

 

[YouGotMyMoney]

What happens if UHC wins and you call your doc and say "who is the best company when I am picking my plan?". "Sorry, I am not allowed to help you with that."

And with all the calls for more rate transparency, this goes against that issue, too.

My two cents. I could be totally wrong. Happens all the time.....

It is highly inappropriate for a doctor's office to recommend an insurance carrier, when that reco is based on what? It should be illegal for a non-licensed entity to give out insurance recommendations, when you have to obtain a license + liability coverage to sell insurance. But, lol what am I talking about laws for...this country wants to elect a criminal to the highest office and let's unlicensed EBT recipients work at the Healthcaregov call center dispensing advice based on what they heard on the morning bus ride into work.

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This sounds like a scam right out of an episode of the Sopranos, maybe even the pilot episode LOL! Anyway go for it UHC, MCare would approve $300 and ACA reqs say $4k, def scam there - go for it!

 

[kgmom219]

It is highly inappropriate for a doctor's office to recommend an insurance carrier, when that reco is based on what?

OH BULL.

They do it all the time. Either based on which carriers they are contracted with or how items are paid.

You sell a bunch of MAPD, correct? Don't your T65s call their docs and ask which MAPD plans they take? You think the people answering don't say "We take X company, but hate them. Buy Y company"

Last year, I had a few docs offices who had no idea that there was only 1 plan they would be in network for ACA who started sending me people, so the patients could be on a plan that is in network for their office. Is that unethical? But when you are losing patients and they ask "which plan do you take", what are you supposed to say? Do you own research????

 

[YouGotMyMoney]

OH BULL.

They do it all the time. Either based on which carriers they are contracted with or how items are paid.

I'm saying they should not be allowed to, not questioning whether they do it or not. Besides, 90% of the girls who work in the insurance verification "department" at the doctors offices - are complete idiots. Why should any patient take their recommendation, when they don't even know what plans their contracted with?

But when you are losing patients and they ask "which plan do you take", what are you supposed to say? Do you own research????

They should refer them to a licensed insurance agent, which of course of they did - guarantee there would be a kickback involved, illegal... Or even worse refer them to the marketplace..... They should simply state the plans they are contracted to accept.... Otherwise you get a bunch of stupid calls from uneducated clients about "my doctor says they accept Blue Cross PPO" .... Blah blah blah lol.

 

[kgmom219]

I'm saying they should not be allowed to, not questioning whether they do it or not. Besides, 90% of the girls who work in the insurance verification "department" at the doctors offices - are complete idiots. Why should any patient take their recommendation, when they don't even know what plans their contracted with?



They should refer them to a licensed insurance agent, which of course of they did - guarantee there would be a kickback involved, illegal... Or even worse refer them to the marketplace..... They should simply state the plans they are contracted to accept.... Otherwise you get a bunch of stupid calls from uneducated clients about "my doctor says they accept Blue Cross PPO" .... Blah blah blah lol.

"Guarantee there would be a kickback involved, illegal"

Are you implying that I would do something illegal? Seriously?

 

[YouGotMyMoney]

"Guarantee there would be a kickback involved, illegal"

Are you implying that I would do something illegal? Seriously?

Do you have an issue with reading comprehension? I was speaking generally.... If doctors offices worked with insurance agents on a large scale to refer patients... There would be 100% an issue with kickbacks.

 

[FLM2]

This sounds like a scam right out of an episode of the Sopranos, maybe even the pilot episode LOL! Anyway go for it UHC, MCare would approve $300 and ACA reqs say $4k, def scam there - go for it!

Scam whoever you want, but remember-respect da Bing!

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OH BULL.

They do it all the time. Either based on which carriers they are contracted with or how items are paid.

You sell a bunch of MAPD, correct? Don't your T65s call their docs and ask which MAPD plans they take? You think the people answering don't say "We take X company, but hate them. Buy Y company"

Last year, I had a few docs offices who had no idea that there was only 1 plan they would be in network for ACA who started sending me people, so the patients could be on a plan that is in network for their office. Is that unethical? But when you are losing patients and they ask "which plan do you take", what are you supposed to say? Do you own research????

Usually the doctor's offices don't say that, they say 'don't give up your Medicare', meaning not to enroll in any MAPD plan. I've had that happen countless times even though it's never cost me a client.