HARTFORD (CN) – A group of major health insurers including Blue Cross and Humana conspired to depress reimbursements for out-of-network medical services thereby forcing patients to pay a greater share of the cost, says a class antitrust action in Federal Court.
Plaintiffs claim the conspiracy, which had begun by Jan. 1, 2004 and continues today, forces policyholder to pay “unlawfully inflated out-of-pocket expenses”.
They claim the defendants used the Ingenix database “to determine their ‘reasonable and customary’ rates. The Ingenix database uses the Defendants’ billing information to calculate a reasonable and customary rate for individual claims by assessing how much a similar type of medical service would typically cost, generally taking into account the type of service, physician, and geographical location.”
However, the complaint states, “A recent New York Attorney General investigation shows that the reasonable and customary rates produced by Ingenix were remarkably lower than the actual cost of typical medical expenses. By manipulating the reasonable and customary rate, the Defendants were able to keep their reimbursements artificially low and force patients to absorb a higher share of the costs for out-of-network services”.
Here are the defendants: Ingenix, United Health Group, Oxford Health Plans, Cigna Corp., Empire BlueCross BlueShield, Humana, Group Health Insurance, Health Insurance Plan of New York, and Health Net.
Plaintiffs are represented by Scott + Scott of Colchester, Conn.