‘Sociopathic’
Jan 13th, 2008 at 12:12 am by Susie
From a hospital executive who filed the RICO action against UnitedHealthcare:
We witness on a daily basis an almost sociopathic willingness by HMOs to ignore laws and regulations originally promulgated to protect consumers and providers. Their ability to avoid effective regulatory enforcement and meaningful penalties, including the possibility of revocation of their license to operate within our State, has only emboldened these HMOs. Avoiding payments to hospitals and other providers of care by placing barriers to appropriate care, refusing payments (i.e. denials) or indefinitely delaying payments for appropriate services already provided in good faith, refusing to recognize inquiries or to fairly negotiate, are just some of the consequences which without doubt have severely compromised the availability and quality of health care as well as patient and provider satisfaction. Their demonstrated standard business practices and policies have progressively crippled hospitals struggling to continue to provide excellent care in the face of decreasing reimbursements and increased costs of operation.
Having worked in the field for years I’m not surprised by any of the charges in this claim. In fact you could put any insurance companies name in there and it would remain believable. I know that we always seemed to have the legal department involved in disputes with various companies.
The one charge of the insurers not wanting to negotiate in good faith is very true. In the Philadelphia region it’s particularly bad with Independence Blue Cross since they control something like 70% of the market. The other insurer that you could never negotiate with was Medicare who tells you what they will pay and it had little to do with the reality of true costs involved in the care. Then you get the double whammy with Medicare of that they make the rules so vague that it encourages seeking more money in the gray areas. But then when the loophole is discovered the government comes after the hospitals with the full legal weight of the government behind the claim.