United Health Group and Aetna Can Suck It!

To the tune of $370 million combined for the pesky little problem of deliberately screwing over plan members on OON (out-of-network) claims. Of course, neither company admits any wrongdoing, but at least UHG thinks settling the lawsuit is in the best interest of the company going forward. Ya think?

And, what a crock of steaming shit is their assertion that there is absolutely no conflict of interest in owning a company, Ingenix, that determines the rates they and other insurers pay for claims, that there is absolutely no incentive to lowball the data to skew those oh-so-reviled "reasonable and customary" rates downward, thereby shifting more of the cost burden to plan members. Don't even get me started on the many layers of secrecy under which reasonable and customary reimbursement rates are buried. Insurance companies go to extraordinary lengths to keep this information proprietary and most importantly, private. Perhaps, this new non-profit organization will increase transparency, but I'll believe it when I see it. Who do you think it's going to employ? My guess is former insurance executives and industry whores, not advocates for the common good.

Full disclosure--I used to work for a subsidiary of UHG. This company has zero concern for plan members. Their entire focus is on maximizing profit, increasing the share price, and enriching the top brass. I was working there, in fact, when the backdating stock options scandal broke, and "poor" CEO McGuire resigned over his $1.6 billion folly. You should have seen the way the "Human Capital" department (yeah, that's what they call it--humans are commodities, folks!) tried to spin this shit internally--lots of blather about focusing on the consumer (we were instructed never to call them members; they're CONSUMERS!) and providing excellent service. Like, when did we ever do that?

I'm glad they're having to cough up some cash, but I think in addition to penalties, they should have to go back and re-evaluate each OON claim filed dating back to 2000 and reimburse plan members. It would probably hamper their current operations, but they're big on out-sourcing, so I'm sure they'd just foist this task on some contractor in Jamaica or the Philippines. They'll be back to their old tricks in no time. They'll find some other way to screw the "consumer," most likely by stalling payment of legitimate claims and increasing the red tape with billing. Until we get rid of for-profit insurance companies, there will be no justice in healthcare.