I don’t know if this is in network or out of network and the reason I mention this is that it sound similar to the old Ingenix out of network algorithms that were used and then declared low-balled and led to the AMA lawsuit against the company for short paying doctors for 15 years. 

New Fair Data Base Slated to Be Available Later this Year To Replace the Corrupted Data Base Used by Ingenix to Calculate Out of Network Insurance Charges

At any rate the basis sounds the same with some “killer algorithms” here miscalculating what the patients owed and were over charged from both Optum Health and Oxford.  If you remember back it was Oxford that for years fought a court case and it ended up in the Supreme court to make the final decision that doctors could group to litigate with insurers.  

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

We have this going on and then yet this woman was paid by United to the sound of $175,000 to fix a hammer toe so we have odd calculating algorithms models here it sounds like that could use some checking for accuracy.   BD

$175,098.80 To Fix A Hammer Toe Billed by New York Podiatrist And the Insurer Paid It, Well Sort Of As They Sent the Check to the Patient By Accident, A New Investigation For “Out of Network” Charges Has Resulted

BROOKLYN, NEW YORK, USA, June 23, 2014 /EINPresswire.com/ -- The Maul Firm, P.C. is investigating claims on behalf of health insurance participants relating to UnitedHealthCare’s coordination of benefits with Medicare. Participants with potential claims are advised to contact Anthony F. Maul, Esq. at afmaul@maulfirm.com or (646) 263-5780.

The investigation concerns allegations that UnitedHealthCare systematically under-reimburses its Medicare-eligible members by manipulating insurance benefit calculations. Potential claimants include Medicare-eligible patients who were insured by UnitedHealthCare (including by subsidiaries Oxford or OptumHealth), and who made out-of-pocket co-payments for health care services.



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