The state medical association put out a release to notify consumers who have Medicare Advantage Policies with United Healthcare, that their state is next on the hit list.  If you go back all of this started in Connecticut and there’s still lawsuits pending on that action taken with the CMA, TMA and other medical associations  who have done a “me too” to join the lawsuit.  A couple weeks ago I ran this post below about how it was impacting folks in Tennessee and you can see in the video and comments that consumers were by algorithmic error being sent to the wrong kind of doctors as a replacement, i.e. gynecologists as their new family practice MD and more. 

Patients In Tennessee Speak Out About United Healthcare Firing Their Doctors As the Effort Continues To Reduce Their Own In House Overhead With Managing Fewer Doctor NPI Accounts, Contracts and Billing…More Killer Algorithms At Work Hurting Seniors

We don’t know how many are affected in Alabama but in each state it has been substantial for sure, such as Massachusetts and New York. As a matter of fact there's a group of lawyers investigating the out of network charges in New York to make sure the insurer is not back up to their old tricks that lead to the bit AMA lawsuit to where doctors were paid short for 15 years on out of network claims due to algorithmic figures in the calculations. 

Law Firm Investigating UnitedHealthCare Claim Payments in New York Stating Under-Reimbursement By Manipulating Algorithmic Benefit Calculations…

Now in New Jersey, the narrow networks are expanding into employer insurance with yet more offering from United Healthcare which gives some kind of price break around 10% for the employer furnishing the insurance, but employees cannot see a doctor or go to a hospital outside of New Jersey. 

Narrow Networks For Employers Soon An Option in New Jersey With “New Jersey Only” Plan Offering From United Healthcare As The Company Keeps Working Their Risk Assessments and Reimbursement Reductions..

The medical board of Alabama is pretty much saying the doctors were fired because “algorithms said”…

On the other hand United and other insurers sure knew how to work their algorithms on over billing Medicare with fiddling with risk and programmatically causing an up coding or up billing situation when parameters were met with those on Medicare Advantage plans, $70 billion over charged in a period of 5-6 years.  So United knows how to play the math model/computer code game very well.  Don’t dare up code on claims submitted to them, but they can do it and get away with it when billing CMS on Medicare Advantage plans and it took CMS 5-6 years to find it.  BD

CMS Discovers That Insurers Offering Medicare Part D “Really Know To Sharp Shoot A Model With Adjusting Risk For Profit”, A Common Everyday Occurrence in Financial Markets…

If you are a patient on Medicare and enrolled in UnitedHealthcare's Advantage program, you may have been notified recently that your doctor is no longer covered in UnitedHealthcare's network of physicians.

That means that if your physician has been dropped from the network and you elect to continue to see him or her, you will likely have to pay more out-of-pocket for your health care.

The physicians of Alabama and the Medical Association of the State of Alabama want all patients affected by UnitedHealthcare's recent decision to know this action was taken unilaterally by UnitedHealthcare. There was no consultation with or input from the physicians who were dropped from the network. Further, the decisions reached by UnitedHealthcare are not an indication of the quality of care provided by those physicians.

http://blog.al.com/press-releases/2014/08/notice_to_patients_regarding_u_1.html

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