- While the weekend has not allowed me enough time to time to read all of the health care provisions of the stimulus bill, I did get a better understanding of the Ingenix usual customary and reasonable (UCR) database litigation pending in New Jersey's federal court. It turns out that while Aetna settled with the New York attorney general, Aetna has not settled its Ingenix related lawsuits pending in that court that was brought by classes of ERISA plan participants (Cooper v. Aetna Health, Civ. Action No. 07-3541 and Seney v. Aetna Health, Civ. Action No. -9-468). Now Aetna also faces an Ingenix-related class action brought by the American Medical Association and other medical societies (AMA v. Aetna Health, Civ. Action No. 09-579). In contrast, United Healthcare, the parent company of Ingenix settled with the New York attorney general and the AMA almost simultaneously. The Hartford Courant reports that
Cynthia Michener, a spokeswoman for Aetna, said her company is "disappointed the medical community has chosen to litigate on top of already pending consumer litigation on the topic."I discovered that there are two ERISA plan participant class actions pending against CIGNA in New Jersey federal court arising out of its uses of the Ingenix UCR database (Franco v. CIGNA, Civ. Action No. 07-6039 and Chazen v. Cigna, Civ. Action No. 08-4106). Cigna, which has not settled with the New York attorney general, was hit with an AMA class action (AMA v. CIGNA, Civ. Action No 09-578). CIGNA issued the following press release about that lawsuit:
She added: "Both members and providers cannot be paid for the same claim under these cases. Ultimately, increasing health care costs increases the number of uninsured and the cost of health care for everyone."
The class action suit filed today by the American Medical Association and other physician groups reasserting prior allegations regarding purported flaws in the Ingenix database is without merit and will be vigorously defended.
CIGNA used Ingenix data to determine reasonable amounts to pay for the small percentage of claims submitted for services provided by non-contracted health care professionals. CIGNA disclosed to doctors and consumers its use of the third-party Ingenix database as the basis of its out-of-network rate calculation. The use of the reasonable and customary methodology is a valuable method for our customers to manage costs and reduce upward pressure on the premium rates paid by individuals while maintaining access to a broad array of doctors.
In keeping with the rest of the industry, many of CIGNA's health plans give individuals the option of choosing to receive care from a physician who is in the company's network or from a doctor that doesn’t have a contract and isn’t in the network. The CIGNA network provides access to doctors who provide high-quality care and who have agreed to charge reasonable fees for their services. If an individual decides to receive care from an out-of-network doctor, then the doctor is reimbursed based on a set, previously agreed upon, fee, and the individual is responsible for the difference between the set fee and the billed charge.
CIGNA’s payments to out-of-network doctors are robust and fair, and greater transparency in regards to physician pricing will prove that point. For instance, for a 15-minute office visit in New York City - the most common service – health plans on average allow $74 to in-network doctors and as much as $160 using the Ingenix database to out-of-network doctors. Medicare pays $70 to in-network doctors and $77 to out-of-network doctors for the same office visit. However, on average, out-of-network physicians (who charge in excess of the amount previously set by the Ingenix database) charge consumers $214 – for the same service. More than 95 percent of office visits are made to in-network physicians today, and CIGNA believes that increased transparency around physician pricing will further support efforts to drive lower cost, high quality care.
All of these cases are pending in New Jersey federal court before U.S. District Judge Faith S. Hochberg.
- In other lawsuit news, the federal judge in the average wholesale price class action litigation pending against First Databank and McKesson set July 23, 2009, as the date for a final hearing on the McKesson settlement agreement valued at $380 million.
- The U.S. Department of Health and Human Services has revamped its HIPAA/ Health Information Privacy website. Health Data Management explains that
Now, it has added content on the Genetic Information Nondiscrimination Act and the privacy provisions in the rules that implemented the Patient Safety and Quality Improvement Act.
For consumers, there also is new information covering such areas as medical records, personal representatives, health information in the workplace, court orders and subpoenas, and notices of privacy practices.
- AHIP announced last week the release of "The National Health Plan Collaborative’s new [web-based] toolkit to reduce disparities in health features innovative health plan case studies; a variety of sample tools, forms and policies related to implementation; and videos of experts talking about the importance of reducing disparities.
- AHIP also released a preliminary analysis of healthcare savings account (HSA) deposits, withdrawals and balances over the 18 month period ending in June 2008. Loads of fun facts such as this
Based on 770,000 accounts for which the age of the account holder was known, the average age of HSA accountholders as of June 2008 was 44.5 years. Approximately 13 percent of accountholders were age 20-29; 23 percent were age 30-39; 27 percent were age 40-49; 26 percent were age 50-59; and 11 percent were age 60 and older.
- USA Today reports that "A new study [published in the New England Journal of Medicine] shows that smokers who earn financial incentives are three times more likely than others to kick the habit. In an experiment with nearly 900 smokers employed by General Electric, 15% of those given incentives were smoke-free after a year, compared with 5% of those who weren't eligible for cash rewards." I find this to be a very sad statement on our culture. Plus where's my payment for not smoking?