Thursday, February 12, 2009

AMA Joins Lawsuit Over Payments

The American Medical Association is joining several state associations in suing two of the largest health insurers over a database they say was rigged to underpay doctors on out-of-network claims for more than a decade. Aetna and Cigna were both basing their payments on the Ingenix database of normal costs. United Health Group already lost $350 million to settle a separate lawsuit involving the AMA and the Ingenix database.

Cigna said prices charged by doctors are part of the problem because doctors in the expensive New York City market charge on average $214 for a 15-minute, out-of-network office visit. Health insurance companies may reimburse as much as $160 based on the Ingenix database while Medicare pays doctors $77 for the same visit.

Looking at those figures is it any wonder the AMA is terrified of a national health plan? Is it any surprise why it's so difficult to find a doctor who will take Medicare today when they can earn so much more for the same amount of time?

Clearly the costs of health care today are at the breaking point snd something has to be done. Cooking the books in a database isn't the way to solve the problem.

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