Thursday 25 June 2009
by: Fawn Johnson | Visit article original @ The Wall Street Journal
Congressional investigators have discovered that large health insurers in every region of the country are relying on faulty databases to underpay millions of valid insurance claims.
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Patients had to make up the difference. It is unclear how much they have overpaid over the years.
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Providers and patients have suspected for years that insurers were underpaying for out-of-network care, but they haven't been able to prove it.
Committee investigators found that Ingenix developed its payment models based on claims data provided by its customers, the insurance companies.
A committee aide said those companies sometimes would "scrub" the data sent to Ingenix - throwing out outlying high costs. Ingenix then would use questionable statistical models to come to its own rate estimates. ...
Republicans and other champions of private-sector insurers have long argued that making health care more consumer-friendly would drive down costs because patients could "shop around" for the best care.
But Sen. Rockefeller and other health-policy experts argue that the lack of information in the private health-insurance market has made competition and informed consumer choice almost impossible.
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