“UnitedHealth had already reduced payments from 450% of what Medicare pays — the benchmark that many insurers use as a starting point for their own figures — to 250%, and the company planned to drop it further to 150%, according to the email……..Such a cut would have put UnitedHealth below national averages: Employers and private insurers paid on average about 250% of Medicare’s reimbursement in 2022…..”
Insurer emails reveal tension over cuts to doctors’ pay | Insurance Business America
By John Tozzi
UnitedHealth Group Inc. systematically cut what it paid for emergency room visits and mental health care to doctors outside of its network, sparking internal tension over how those changes were handled and the potential effect on members, newly unsealed court documents show.
The records open a window into the workings of its UnitedHealthcare unit, the largest US health insurer, and shed light on a bitter battle between financial heavyweights in the $5 trillion US medical system. Doctors have long blamed the company for refusing to fully cover their bills, with private equity-backed physician groups filing a string of lawsuits accusing it of short-changing clinicians from outside of its insurance network.
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94% or private health plans continue to subscribe to managed care networks they can’t see nor audit. Someone else is deciding what prices consumers must pay for health care and insurance companies make sure they do.
Why do most managed care networks pay primary care physicians less than Medicare when they pay hospitals 250-500% of Medicare? Who decides that?
Why do carriers pay out-of-network hospitals 105-115% of Medicare when they pay in-network hospitals double and triple that? Who decides that? Shouldn’t it be the other way around?
How is value calculated? Or does value matter?
Why do carriers second guess physicians by requiring pre-certification? Who decided that was a good idea?
There is no free market in American health care finance. Consumers are getting screwed and they don’t care. They are assured “Don’t worry, you have insurance!!”
