WASHINGTON, Jun 24, 2009 (UPI via COMTEX) -- U.S. consumers have been forced to
pay billions of dollars in medical bills health insurers should have covered, a
Senate committee said Wednesday.
That's because private insurers have systematically underpaid for out-of-network
care, the Senate Commerce Committee said in its report.
Insurers normally pay a percentage of the "usual-and-customary" rates, but the
process remains a mystery to most consumers and is difficult to challenge, The
Washington Post reported.
The report says insurers typically relied on numbers from Ingenix Inc., a wholly
owned subsidiary of health insurer UnitedHealth Group, to determine
"usual-and-customary" rates for out-of-network care, the Post said. Ingenix
determined benchmarks that kept usual-and-customary rates low, placing more of
the cost burden on consumers, the report said.
The report also revealed the Ingenix data came from the insurers that bought the
company's information and that insurers often removed high charges from their
data, the Post said.
In March testimony to the Commerce Committee, UnitedHealth Group's chief
executive, Stephen J. Hemsley, said he regretted the conflict of interest
between his company and Ingenix, the report said.
But Hemsley said he stands by the integrity of the Ingenix data and the way the
insurer used the data, the Post reported.
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