PAYING FOR YOUR TREATMENT

This is an overview of the subject. There are links to detailed information here and at www.hypertext.org/ ENGLISH / PAY.html   (revised August 2009)

This is an overview of the subject. Follow the links to more-detailed information.
When printed, this text is nine pages long.

 

This information is for citizens of the United States, the only major industrialized nation with major health insurance problems. You won’t like what you read here. Ignore it at your own risk.

 

     CONTENTS

As if it weren’t enough that you have to deal with cancer, you also have to navigate the business side of medicine.

IF YOU HAVE HEALTH INSURANCE

There is no guarantee you’ll get every treatment or drug you may need, or that you won’t have to declare bankruptcy. That’s right, medical expenses were the cause of 73,350 personal bankruptcy petitions in the U.S. in 2007. And three-quarters of those people had health insurance.1

Are you underinsured?

Many plans and policies simply do not provide sufficient coverage. People who pay for their own insurance tend to pick less-expensive plans. And that is also what most companies now offer their employees.

Because those limited-benefit policies do not provide enough coverage, more than 25 million Americans are dangerously underinsured.2

 

Types of health insurance in the United States
http://en.wikipedia.org/wiki/Health_insurance_in_the_United_States

Some Things to Watch Out For

What some insurers have been known to do to save money:

DENY TREATMENT

Some insurers apparently deny treatments simply because they have found that many people don’t have the time, energy, or knowledge needed to fight them—especially if they are facing an emotionally draining disease like cancer.

On what grounds do they deny benefits? They might say that the treatment you want is “experimental,” not medically necessary, or that you failed disclose a past illness or pre-existent condition.

The bottom line, says a former executive of the National Association of Insurance Commissioners, “is that insurance companies make money when they don’t pay claims.”3

CANCEL POLICIES

In 2009 Congress investigated three insurance companies that had canceled 19,776 policies in five years, saving themselves $300 million. At a House subcommittee hearing, the CEOs of Assurant Health, UnitedHealth’s Golden Rule Insurance Co. and WellPoint’s Consumer Business were asked if they would consider ending the practice except in cases of actual fraud. All three said no.4

The average amount saved by Health Net was about $20,000, the other three around $15,000. More or less the price of a prostatectomy or a broken leg.

Health insurance application forms can be long and complex, and few people are able to remember every illness or doctor visit, so it’s easy to make unintentional mistakes. But the insurer is unlikely to do more than a cursory check of the information unless you develop an expensive illness.

ENCOURAGE BUREAUCRATS TO OVERRULE DOCTORS

In 2008 the Medical Society of the State of New York asked 1,200 physicians if insurance companies pressure them.5

And it’s not just the bureaucrats. Clerks are given guidelines, and they don’t risk straying from them. If your doctor says you should have a specific test, drug, or procedure, make sure no one replaced it with a less-expensive or inappropriate one from the guidelines.

Even personnel you might expect to be qualified may not be. If you ever need a PAP (serum prostatic acid phosphatase) test, make sure the technician understands exactly which test this is—especially if he/she gives you a strange look.

MAKE PHYSICIANS BUDGET HEALTHCARE

In some plans, the bureaucrats allot each doctor and specialist a lump sum per subscriber to spend on patient care (capitation). The physicians can keep whatever is left at the end of the year, but in many cases it probably ends up costing them money. But the fact that the executives are paid so much more than the physicians must make it tempting to cut corners.

CUT CORNERS

One way to reduce costs is to skimp on equipment (such as not buying an ultrasound-guided gun for prostate biopsies). Another is to take chances with patient health, which happened in a Nebraska clinic where 99 cancer patients were infected with hepatitis C during chemotherapy, because syringes and other single-use medical equipment were reused in order to save money.6

PAY LESS THAN THEIR SHARE OF OUT-OF-NETWORK COSTS

Subscribers whose policies allow them to be treated by a physician or in a hospital not associated with the insurer), split the charges with the insurer. The company agrees to pay 60-80% of the “usual and customary” cost of a service and the subscriber agrees to pay the rest. Typically, however, the insurer’s idea of usual and customary is much lower than the amount that was charged, and the subscriber is forced to pay the difference. For years the figures for the health-insurance industry were based on rigged numbers supplied by Ingenix, a company owned by UnitedHealth.7

MAKE INTENTIONAL BILLING ERRORS

The CEO of a claims-processing company has said that “About 40% of denials occur because of incorrect information—the wrong insurance card or address or other information.”8

But not all misbillings are the result of carelessness. Some are scams, like billing for services that were not performed, charging for a more expensive service (upcoding), billing separately for tests or procedures performed at the same time by the same person (unbundling), and not returning overpayments.

It pays to check your bills carefully, but because of the confusing codes the insurers use, you may have to hire a medical billing advocate. (See the links that follow Reviews and other solutions, below.)

The most common type of billing fraud (perhaps because it is so difficult to detect) may be the practice of overstating costs, as when a hospital gives an insurer large discounts on the insurer’s portion of the charges–but the patients are charged 20% of the undiscounted price.9

SETTING UNREALISTIC LIMITS

Many of the less-expensive policies can run up your bills with high deductibles (how much a subscriber must pay for one or all services or items before the insurance kicks in), copayments, also called copays, (the fixed amount a subscriber pays for specific services, such as an annual physical), coinsurance (the percentage a subscriber must pay for specific services), and out-of-pocket maximums, OOPs for short, (the maximum amounts a subscriber must pay for something before the insurer begins to pay). There are also caps (limits) on specifics or overall or even lifetime coverage, and exclusions (a list of drugs, treatments, and other things the insurer will not pay for).

 

Hidden Costs of High-Deductible Health Insurance
http://tinyurl.com/kq3zvh

 

HOW TO PROTECT YOURSELF

READ THE FINE PRINT

This is good advice when picking a policy. If you already have a policy—and a problem—re-read it. Carefully.

TAKE NOTES FROM DAY ONE

It’s worth the effort to organize every bill, notice, and so forth as they come in. If there are no problem, fine. If there are, you’re all set to mount an appeal.

DOUBLE-CHECK EVERYTHING

Every time your doctor orders or prescribes something, make sure nothing has been changed by clerks or bureaucrats.

The following are suggestions. Read your policy information to find out what the process is for your insurance company/MCO.

IF THERE IS A PROBLEM

If a claim or treatment is denied, write the company immediately. Explain the problem (and don’t forget the claim number). A paper trail is important. If you have to use the phone, write down every name, time, date, and other details.

Insurers and MCOs are required to make every denial in writing.

If the problem is an incorrect substitution, use the phone, especially if the date of the treatment or prescription need is near. Call Customer Service. If the clerk refuses to correct the error, ask to speak to a superior.

If they give you a run-around, try to get them to commit to a date on which they will respond. Write your doctor about the problem and the steps you have taken. Write a letter to the department explaining the problem. It’s sending any important letter by certified mail and requesting a signed receipt.

If they haven’t contacted you in ten business days after you mailed the letter, keep after them. If big money is involved, they may be hoping you will give up, that the appeal period will run out, or you’ll die.

If your appeal is turned down, you may be able to resubmit.

IF ALL ELSE FAILS

If they ignore you or state that the decision is final, contact your state’s Department of Insurance. If there is an independent appeal board, file an appeal. If your health is in danger, contact every politician who represents you at any level.

If the insurer sends you a letter advising you of an appeal you can attend, and it arrives just before or sometime after the hearing, contact your state’s Department of Insurance.

REVIEWS AND OTHER SOLUTIONS

Some companies have second- and third-level appeals, some of which may be done by an independent review organization. Check with your state insurance commission to find out what appeals are available to you.

Resources for Health Insurance Appeals
http://tinyurl.com/loq24x
How to appeal a denial
http://tinyurl.com/lsolba
Sample claims appeal letter
http://www.healthsymphony.com/appeal.htm
Another sample
http://www.appeallettersonline.com/
Medical billing advocates
http://www.nytimes.com/2009/08/08/health/08patient.html
Medical Billing Advocates of America
www.billadvocates.com

 

In 2000 the Supreme Court ruled that, under the Employee Retirement Income Security Act of 1974 (ERISA), HMOs cannot be sued for “treatment rationing.” (Pegram v. Herdrich, No. 98-1949) Congress set out to fix this with a “patient bill of rights” but couldn’t agree on what those should be. The Court expanded HMO protection in 2004 by capping awards at the cost of whatever was improperly denied. (Aetna Health Inc. v. Davila and Cigna Healthcare of Texas Inc. v. Calad)

Patient advocates

There are general advocate organizations, some that serve particular communities, and some that are dedicated to specific diseases. There are also individuals who perform this work. They might offer legal advice, help with expenses, or other services as well as dispute resolution. In some cases, advocate services are free, but most must be paid. Some may be willing to take a portion of recovered funds as payment.

 

How Advocacy Organizations Can Help
http://www.cancerfac.org/reading/advocacy-orgs.php
About patient advocacy
http://en.wikipedia.org/wiki/Patient_advocate

 

IF YOU LOSE YOUR HEALTH INSURANCE

If you lose employer-sponsored insurance, you may be able to:

• join your spouse’s plan.
• buy individual insurance.
• join a group plan.
• qualify for a government plan.
• extend it with COBRA

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) allows you to remain in your former employer’s plan for a number of months, provided you pay the full cost of the insurance plus a small fee. In 2009, subsidies that are part of the Stimulus Bill may help your coverage last longer and cost less.

If you don’t qualify for COBRA because your former company was too small, find out if your state has a mini-COBRA law that covers you. (Do not confuse these with an insurance company that calls itself Cobra.)

If you move from one job to another where you will also will be covered, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) should protect you. There will be no waiting period, no exclusions for pre-existing conditions, or additional deductibles. But if you do have a pre-existing condition, insurers in states that do not have premium caps may drastically raise your premiums.10

If you have a health savings account (a tax-sheltered investment that can only be used for medical expenses) and a fair amount of other savings, you may be able to squeak by. Because the plan is relatively new, has very high deductibles, and the amount you can deposit each year is limited, you probably have not built up much of a reserve. If you put it in the market, you may not have any. (These accounts have been described as “a bet against yourself.”)

When you are denied health insurance
www.msnbc.msn.com/id/26664727/
Consumer Health Resources at Public Citizen
http://www.citizen.org/hrg/links/index.cfm

 

IF YOU DON’T HAVE HEALTH INSURANCE

“Competition in insurance markets is often about getting the lowest risk enrollees as opposed to competing on price and the efficient delivery of care.”11

Refusals can border on the absurd, as in the case of a Minnesota woman turned down for an individual policy by Blue Cross and Blue Shield. The reasons: “She was using topical medication for acne, she had once sought emergency care for a migraine and she was on Paxil, a drug for anxiety and depression.”12

Only five states prohibit turning people down for pre-existing conditions (Maine, Massachusetts, New Jersey, New York, and Vermont). In other states you may be able to buy a more-expensive policy if your condition is relatively benign.

Other possibilities:

• you may be able to work out payment plans with healthcare providers.
  (See Getting treatment without insurance,below.)
• you may be able to get help from charities or non-profit organizations.
  (See Assistance, below.)
• your state may run a high-risk insurance pool, but it will probably be very expensive and difficult to join
• you may qualify for a government-funded plans at the federal, state, and local level. These include Medicare, Medicaid, military health care, and the Indian Health Service.

Medicare information
http://www.cms.hhs.gov/
Medicare glossary
http://tinyurl.com/m765g
Medicaid information
http://www.cms.hhs.gov/MedicaidGenInfo/
Military health information
http://tinyurl.com/mzmj8q
VA health care glossary
http://www.va.gov/healtheligibility/Library/Glossary/
American Indian/Alaska Native information
http://www.cms.hhs.gov/center/ir.asp
About high-risk pools
http://healthinsurance.about.com/od/highriskpools/a/hrps.htm
State-sponsored risk pools (scroll down)
http://www.healthinsurance.org/risk_pools/
States That Have Risk Pools: URLs and phone numbers
http://tinyurl.com/kpdbpf

WATCH OUT FOR FAKES AND HARD-SELLS

There are many bogus companies selling bogus policies. In the years 2000 through 2002, the General Accounting Office identified 144 such companies. “These unauthorized entities covered at least 15,000 employers and more than 200,000 policy-holders. The entities also left at least $252 million in unpaid medical claims.” (GAO-04-512T) Many use names that sound familiar or are similar to those of legitimate firms.

In June 2007, the Centers for Medicare and Medicaid Services received 2,700 allegations of illegal, aggressive, and deceptive sales tactics by agents of seven of the largest insurance companies.

Some agents claimed to be from Medicare, forged signatures, or failed to tell people that the costs were higher in those Medicare Advantage plans. (But at least they did not deny anyone for pre-existing conditions, even going so far as to enroll several people who were dead.)13

Senior citizens should be especially wary of private fee-for-service (PFFS) Medicare Advantage plans, which are not accepted by all providers. As a result, the nearest hospital willing to admit you may be more than an hour away. Unfortunately, some retirement plans are switching from supplementary insurance to PFFS plans, leaving their enrollees in a bind.

Discount plans or cards take a monthly fee in exchange for healthcare discounts, but they can only be used with providers willing to accept them. At least one company has told prospective clients that these are insurance policies.

Risk-sharing plans put everyones’ monthly payments into one account. The idea is that you can draw on this if you incur large healthcare costs. At least, that’s the idea.

 

GETTING TREATMENT WITHOUT INSURANCE

Medical expenses are impossibly high for an uninsured person, but you may be able to bargain with providers. Doctors, labs, and hospitals are used to negotiating with insurers, and they may be willing to give you some of the same breaks and to let you pay in installments.

 

Finding treatment (Dept. of Health and Human Services)
http://findahealthcenter.hrsa.gov/
Resources and Information on Provider Quality of Care (by state)
http://www.healthcarebluebook.com/page_QualityResources.aspx
Using the Healthcare Blue Book to Find a Fair Price
http://www.healthcarebluebook.com/page_FindFairPrice.aspx
Negotiating with a doctor
http://www.healthcarebluebook.com/page_ContactDoctor.aspx

ASSISTANCE

There are organizations and charities that help the un- and underinsured. Drugs, travel, and dealing with debt collectors are among the topics. But when money or services are given away, delays, restrictions, paperwork, complications, and other problems may pile up. For example, you might be able to find a free space on a private flight if you have to go to for cancer treatments in a distant city. But if their plans change at the last minute, you’ld be forced to buy an expensive commercial ticket.

 

Financial Assistance and Other Resources for People With Cancer
http://www.cancer.gov/cancertopics/factsheet/support/financial-assistance
Financial Help for People with Cancer (PDF)
http://www.cancercare.org/pdf/fact_sheets/fs_financial_en.pdf
Financial resources
http://tinyurl.com/lfnnje
General Support Information
http://tinyurl.com/lqbtdp
Finding assistance
http://www.cancerfac.org/
Obtaining less-expensive drugs
http://tinyurl.com/a5x8
Consumer Health Resources
http://www.citizen.org/hrg/links/index.cfm
Access Project (help with medical-debt problems)
www.accessproject.org

 

The New York Times publishes a very helpful series of articles called Patient Money. They include such titles as Bargaining Down the Medical Bills and Advice to the Jobless on Getting Health Coverage.

 

Patient Health articles
http://tinyurl.com/nkxvor
More Patient Health articles
http://well.blogs.nytimes.com/tag/patient-money/

MEDICAL TOURISM

If you can’t get treatment, you might do what some of the insured do when they are denied treatment: travel to a country where healthcare is more affordable. Finding a reliable provider may not be easy, but there are magazines, Web sites, and travel agencies that offer advice.

Much outsourced medicine is probably as good as what many low-rent U.S. HMOs offer, and it can cost 10-50% less than what it would cost an uninsured person in this country. The Deloitte Center for Health Solutions has estimated that more than 6 million Americans will leave the United States for medical treatment in 2010.

 

Medical tourism (overview)
http://en.wikipedia.org/wiki/Medical_tourism
Medical tourism (assessment)
http://www.nytimes.com/2009/06/10/opinion/10milstein.html
WHO assessment of the world’s health systems
http://tinyurl.com/yqwkwm

 

And that’s not all, folks

Hospitals, medical personnel, drug companies, and others can also run up your costs both intentionally and through error. They can also give you infections and other things you don't want but will be charged for. Some of this may be dealt with eventually on another page of this site. Meanwhile, read some books and articles.

If you’re curious about why insurers feel the need to deny treatment and dump patients, read on.

What do insurers do with all that money?

More than half is spent on necessary medical expenses. The rest goes to:

UNNECESSARY MEDICAL EXPENSES

A major problem is that the fee-for-service system encourages physicians, hospitals, and Medicare MCOs to order expensive tests. Another big problem may be the lack of accurate information about the effectiveness of tests and procedures.14 It is also claimed that a fear of malpractice suits leads providers to order extra tests (although the Supreme Court seems to have severely limited such suits, at least in MCOs).

PAYING LARGE FINES

You have already seen examples of how attempts to scam or shortchange can lead to fines and settlements that run to hundreds of millions of dollars. Here are a few smaller examples:

• Blue Shield, $12,600,000 for more than 1,200 violations. (California Department of Insurance, 13 December 2007)
• HealthMarkets, Inc., $20,000,000 settlement for “multiple problems involving consumer disclosure, oversight and training of agents, claims handling and complaint-handling practices.” (National Association of Insurance Commissioners, 24 July 2008)

ADMINISTRATIVE EXPENSES

Large staffs are needed to fill specialty jobs like finding reasons to dump subscribers and to deal with all the paperwork. About 30 cents of every healthcare dollar goes for administration, principally billing.15

And there are perks. In the nineties, HIP, a New York HMO, leased two Jaguars and a $7000-a-month apartment near Miami for their CEO to use as he unsuccessfully (and expensively) attempted to expand the HMO into Florida and New Jersey.16 And after being ordered by state regulators to reduce administrative expenses, HIP spent $200,000 to send some marketing employees on an excursion to Puerto Rico.17

ADVERTISING

As you know, pharmaceutical companies spend huge amounts pushing drugs on TV. The advertising campaigns of insurance companies and MCOs are less obvious, but they are substantial. Even AARP, which gets royalties from the policies UnitedHealth sells using its name, spends millions every year to advertise those policies.18

LOBBYING

There are more than 3,000 healthcare lobbyists prowling Congress at any time, but this year 350 former government aides and ten former members of Congress have been hired to enhance access. And spending, which more than doubled in the past ten years, has gone through the roof—more than $1.4 million a day even before the August smackdown, according to disclosure records.19, 20

SHAREHOLDERS

Investors no longer invest, they look for quick profits. The more a company can pay its shareholders, the higher its stock price will go—and the greater the rewards for executives with stock options. And you already know how they maximize profits.

HUGE EXECUTIVE SALARIES

The record for CEO compensation is $124,800,000, held by William McGuire, former head of UnitedHealth. That is almost the equivalent of the annual premiums of almost 34,000 subscribers.20 Pay for some other CEOs that same year were $13,312,000 at Cigna and $22,219,000 at Aetna.21

Why are the CEOs of HMOs paid so much more than the President of the United States? According to Mary Mundinger, dean of the Columbia University nursing school and formerly a well-paid UnitedHealth director, McGuire “needs to be compensated appropriately so that his business model has believability in the market.”22

McGuire had to step down after it was learned that he had back-dated hundreds of millions of dollars' worth of stock options. UnitedHealth had to pay shareholders a $895 million settlement as a result. (How many annual premiums would that be?)23

THE NEED FOR HEALTH REFORM

If you’ve read this far, you know why we need health reform.

A single-payer system is probably the best solution, but the insurance companies will not allow Congress to create one. A public option and the right to choose any plan would at least enable the American public to vote with their feet.

As Congress tries to write a plan that doesn’t offend the insurance lobby, chances of real reform are growing dim. There’s a lot of talk about the free market and your right to choose, but if an insurer dumps you, you probably won’t have many choices left.

Government-run insurance would have many reasons to economize, but not on the scale or with the cold-bloodedness that these virtually unregulated, for-profit companies do. Nor would there be as much administrative waste or bloated salaries. Write your senators and representatives, and tell them we want a plan that will really give us choices.

Find your Senators
http://www.senate.gov/general/contact_information/senators_cfm.cfm
and your Representatives
http://www.house.gov/house/MemberWWW_by_State.shtml and the names of the Blue Dogs
http://tinyurl.com/koxzzd

 

FOOTNOTES

1. Medical bankruptcies Researchers from Harvard Medical School, Harvard Law School, and Ohio University examined a random national sample of 2,314 bankruptcies filed in 2007. These were deemed “medical” if they were due to illness and the size of the medical debts. In 78% of the cases, the filer had medical insurance at the beginning of the illness. (American Journal of Medicine, August 2009)

2.The underinsured A Commonwealth Fund study found there were 25 million underinsured adults in the United States in 2007, a rise of 60% in just four years. (“How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007,” Health Affairs Web Exclusive, 10 June 2008)

3. Claims hurt profits Mary Beth Senkewicz, in “Aged, Frail and Denied Care by their Insurers,” New York Times, 26 March 2007.

4. Cancelations will continue “Insurers Revoke Policies To Avoid Paying High Cost,” NPR Morning Edition, 22 June 2009)

5. Overruling doctors “Survey Reveals that Doctors Feel Pressured by Health Insurers to Alter the Way They Treat Patients,” www.mssny.org, 2 September 2008

6. Cutting corners “Latest outbreak ‘haunts’ Fremont’s McKnight,” Fremont Tribune, 6 March 2008

7. Underpaying out-of-network fees Until recently, the preferred tool for determining costs was a company called Ingenix, a wholly owned subsidiary of UnitedHealth Group. Ingenix collected data from insurers, some of whom adjusted their real rates downward to skew the results. Ingenix would often manipulate the data as well. Because of this, patients were stuck with their share plus whatever Ingenix said was above the usual-and-customary figure.

New York State Attorney General Andrew Cuomo said of the Ingenix affair, “for years consumers were consistently low-balled to the tune of hundreds of millions of dollars.”

UnitedHealth did not acknowledge any wrongdoing but did pay $350 million to settle a class-action lawsuit brought by customers and providers It must also pay $50 million to create a new database that will be run by a nonprofit organization. Aetna has to pay $20 million and CIGNA $10 million. (“UnitedHealth settles Ingenix suit,” Star Tribune, Minneapolis-St. Paul, 15 January 2009)

8. Misbilling “The Check Is Not in the Mail,” New York Times, 25 May 2006)

9. Overstating costs In a Supreme Court case, a hospital was found to have given Humana “large discounts on the insurer’s portion of the hospital’s charges for care provided to the beneficiaries. As a result, Humana Insurance paid significantly less than 80% of the hospital’s actual charges for the care that beneficiaries received, and the beneficiaries paid significantly more than 20%.” (HUMANA INC. et al. v. FORSYTH et al., January 20, 1999)

Medicare is frequently over-billed. Senator Martinez (R-Florida) said “rampant fraud perpetrated against health care resulting in more than 60 billion taxpayer dollars lost every year.” And Senator Sanders (I-Vermont) said investigators “found that 80 percent of insurance companies participating in the Medicare prescription drug benefit overcharged subscribers and tax-payers by an estimated $4.4 billion.”

10. Premium caps “What Insurers Are Trying to Get Out of Health Reform,” Time, 6 August 2009

11. No insurance for the unhealthy “Can a Public Insurance Plan Increase Competition and Lower the Costs of Health Reform?” Urban Institute, Health Policy Center, 2008

12. Refusals “Insurance denial can seem arbitrary,” Star Tribune, 10 January 2009

13. Fakes and hard-sells Kaiser Daily Health Policy Report, June 18, 2007. Although cases were reported in 39 states, the insurers claimed ignorance.

14. Ineffective procedures A recent study of a treatment for spinal fractures found it was no better than a placebo. Yet Americans have 73,000 of these expensive procedures each year. The New England Journal of Medicine, 6 August 2009

15. “Treated for Illness, Then Lost in Labyrinth of Bills,” New York Times, 13 Oct. 2005, 29%; “Costs of Health Care Administration in the United States and Canada,” New England Journal of Medicine, 21 August 2003, 31%

16. Perks “State Rips HIP Exec Perks,” New York Daily News, 5 Nov. 2000

17. Parties “HIP’s 200G hop,” New York Daily News, 29 March 2000

18. Advertising “AARP’s Stealth Fees Often Sting Seniors With Costlier Insurance,” Bloomberg, 4 December 2008

19. Number of lobbyists and amounts spent “Sector Profile, 2009,” http://www.opensecrets.org/lobby/indus.php?lname=h&year=2009

20. Temporary lobbyists “Familiar Players in Health Bill Lobbying,” Washington Post, 6 July 2009

21. Big CEO salaries CEO salaries, 2005, Forbes

22. How to have believability in the market “UnitedHealth Directors Strive to Please Chief,” Wall Street Journal, 18 April 2006

23. The cost of backdating “Federal judge OKs $925M UnitedHealth settlement,” The Associated Press, 11 August 2009

Disclosure: My former HMO committed many errors and omissions, and half the medical personnel I dealt with did not seem particularly competent. I paid for a hernia operation myself because the surgeon made it clear that he didn’t want to do it, and I was able to switch to an out-of-network plan to be treated for prostate cancer.

I stayed with that HMO because, as a freelancer paying for my own insurance, I had few choices.

Some years later in Colorado, I signed up with an Medicare Advantage HMO with a better reputation. They promptly misplaced my past medical records (which I had delivered by hand), billed me for a physical that did not take place, ignored my letter explaining why I should not be billed, and reduced my prescription (of eleven years).

In spite of all this, I did not exaggerate the problems detailed on this page.