Out-of-Network Medical Charges Potential Litigation

Chimicles & Tikellis is investigating whether UnitedHealth, Aetna, WellPoint, Humana, and/or BlueCross/Blue Shield systematically under-pay and under-reimburse consumers for out-of-network medical charges. It has been reported that UnitedHealth relies on "independent research" in setting its reimbursement rates for out-of-network charges, but actually uses a research firm that it owns (called Ingenix) to set these rates. It has also been reported that the Ingenix database was "rigged" and "manipulated" to improperly limit payments from insurance companies to consumers for out-of-network medical charges. Patients generally incur an out-of-network charge when they visit a health care provider (often a specialist) that is outside of their insurer’s network of preferred providers.

C&T is investigating whether these insurance companies’ arrangements with Ingenix has led to the manipulation and underpayment of reimbursement rates. UnitedHealth recently agreed to settle similar allegations with the New York Attorney General. It has been reported that Aetna, WellPoint, and BlueCross/Blue Shield also use Ingenix.

If you are insured by UnitedHealth, Aetna, WellPoint, and/or BlueCross/Blue Shield, and have been under-reimbursed for having a medical procedure performed at an out-of network health provider, please contact me. An ideal plaintiff would be someone who has paid an increased premium for the right to use out-of-network providers, was denied full coverage for out-of-network health services, and who has already appealed this denial.