Are we parents yet?

The Clements’ IVF Journey

Well, well, well… January 16, 2009

Filed under: Financials for IVF — Aria @ 4:43 am

We DEFINITELY aren’t the only ones being screwed by United. UnitedHealth, the parent company of United Health Care, was just ordered to pay $50 million because the database, called Ingenix, used to determine “usual and customary charges” (used in determining how much services should cost, with the client paying everything over) is obviously biased because they own it. This has resulted in clients paying millions more than they should have. This happened to us with the first doctor they sent us to. Our co-pay for specialty office visits is $20 with 100% of usual and customary paid after that. Well, the charge was $180, which is less than the lowest I’ve heard of any of my infertile friends paying, the lowest being $200 for this initial visit. After our $20-co-pay, that lest $160. United covered half of that saying that the usual and customary for an initial infertility appointment is $100 ($100 minus our co-pay left $80). We got billed the rest. Interesting to see they’ve just been ordered to pay millions in New York for their based database. Obviously if you own the database, your employees will want to make it as much in your favor as possible, which is what happened.

Of course there is a complication that will affect other companies. They allowed Blue Cross in Illinois to use their database, meaning Blue Cross may have been (unknowingly, I hope) also short-changing their clients.

They were ordered to pay $350 million in a separate suit today, two days after the one I just mentioned, for using their database to determine how much to pay for out-of-network services, resulting in people being reimbursed far less than they should have been. The New York attorney general calls it a scam. So the first order is to fund an unbiased database, and the second is to reimburse people ripped off.

Mary Jerome was diagnosed with ovarian cancer, and was told by her insurance, Oxford, a company owned by UnitedHealth, that Ingenix determined that many of her treatments, INCLUDING CHEMOTHERAPY DRUGS, “were not considered “usual, customary or reasonable.”” So. Chemotherapy drugs are not a reasonable treatment for cancer. Bull shit. Like IVF isn’t a reasonable family-planning method, even though it’s listed specifically as being covered. Bull shit. At least in Mary’s case, United Health Care in New York (also owed by UnitedHealth) has been “perfect” so far. Too bad United Health Care in our area isn’t perfect. Different region, different assholes, but all owned by the same company that’s in trouble for ripping people off by scamming (the attorney general’s word) people out of scam cost hundreds of millions of dollars (also his words).

As son as we get the statement from United showing what they claim to have been charged by the pharmacy, as well as a statement from the pharmacy of what the actual charges are, I’ll be filing with the insurance commissioner here in California, and sending a copy to the attorney general. It’s not acceptable for an insurance company to lie about what it was charged to get out of paying for more medications. “Over $4,000” for a medication that costs, AT MOST, $238 per vial (11 vial). Yeah. I can’t wait to get the statements.


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