Follow-up: Has anyone had luck getting their insurance to over the over U&C charges at TCI?

November 26, 2008

I will let y'all know how well my appeals go, but I think I may have found

something useful. Ask your insurance company how they determine the UCR rates.

I did and I was told that they contract with a company named Igenix who collects

all the data and computes the usual and customary rates; come to find out the

majority of insurers do use this same company to figure their UCR rates.

Here's the kicker...In February 2008 the New York attorney general started an

industry wide investigation into health insurers' fraudulent reimbursement

scheme and notified Igenix and its parent company United Healthcare Group of its

intent to sue. The head of the AG's task force investigating Igenix said, " Our

investigation has revealed that Igenix is nothing more than a conduit for rigged

information that is defrauding consumers on their right to payment. " (taken from

the testimony I note below)

In my Internet search I actually found the 10/07/2008 testimony of the

Healthcare Association of New York State (HANYS) before the New York Insurance

Department (given by Gold, VP of Managed Care and Special Counsel at

HANYS) and it notes some very interestting things in relation to Igenix.

Anyway, this is where I am going to start and see what else I can find and I

thought there were probably many of you who would be interested in the

information.

Subject: Has anyone had luck getting their insurance to over the over U & C

charges at TCI?

Date: Wednesday, November 19, 2008, 12:08 PM

I just got the bill EOC from Tasha's TC surgery at TCI and the insurance is

claiming that the U & C charges are less than half of what was charged...and that

the surgical procedure is not listed as being applicable for an assistant

surgeon.

We have a local union health trust that is covered under BeechStreet/First

Choice. If anyone has had luck getting the overage covered, please reply back.

Thanks so much,

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