AMA Led Group Sues WellPoint Over Reimbursement

The American Medical Association (AMA) is leading a group of doctors and medical societies in a lawsuit against payer WellPoint, Inc., charging it set reimbursement rates for out-of-network services artificially low.

This California lawsuit follows a series of actions by the New York Attorney General and New York payers over the same issue, which centers around a usual and customer (U&C) database sold by United HealthGroup’s subsidiary, Ingenix.

For more information, go to this link to the story on CNN’s Web site.

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3 Responses to “AMA Led Group Sues WellPoint Over Reimbursement”

  1. John Nelka CPC CPC-H says:

    In addition to low rates for out of network services, Well Point Unicare is clinically inefficient
    on its protocol especially when it establishes experimental and investigational guidelines especially
    for radiation treatment and for Intensity Modulated Radiation Treatment or IMRT Our treatments are
    FDA proven and we should at least have a fair day in court through the arbitration process

  2. summer says:

    Once again it is proven that the insurance companies are not our friends. As a medical coder, biller and A/R collector, I have often known insurance companies to lie in order not to pay claims. They lie to the providers and to the insured. This drives patients and providers costs up and the insurance companies get to keep the money that they should have rightfully paid to medical providers and patients. We need to educate ourselves and stop deceitful practices by insurance companies.

  3. Jo Burt, CPC says:

    There will come a time when physicians offices will have to look at the policies of each insurance company and decide on whether they will acccept the patient who has this type of reimbursement policy. Some physicians in my area are considering not accepting some of these so called Medicare Advantage Plans. Tx Community Care is one that really needs an overhaul..

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