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Physicians prevail over illegal insurance practices


The courts sided with North Carolina physicians over claims that UnitedHealthcare wrongly and systematically denied medical claims. Perhaps the tides are changing?

Sometimes you can just feel change blowing in. That time is upon us now. The bullies from the playground (payers) are starting to bow to push-back from their victims (physicians and patients). Physicians have had it, and they are retaliating against the big insurance companies for bad behavior and illegal practices. They want recourse for all of the hits they've taken over the past several years. They're starting to get it.

An article posted on BizJournal.com reports that the North Carolina Medical Society (NCMS), after 12 years of litigation, has finally won a lawsuit against United Healthcare for $11.5 million. I wholeheartedly applaud NCMS for sticking to their goals and not giving up, particularly after so many years! The lawsuit was not intended to make financial payments to providers, as much as it was to upgrade UHC's provider self-service technology systems. Quite frankly, I'm not sure why they are not already required to maintain and upgrade their data platform, especially being a medical business entity of their size. Regardless, the lawsuit is over, and the little guys won.

Related:UnitedHealth drops more physicians from its Medicare Advantage network

This is just one of many lawsuits going on right now. If you simply Google the term "Blue Shield lawsuit," you'll see that several states and physicians are in litigation with this payer. Patients are tired of being lied to by these insurance companies, and they're supporting these lawsuits, as well. The lawsuits vary from allegedly violating anti-trust laws, to creating plans under the Affordable Care Act that do not have any physicians in their networks - forcing patients to pay more out-of-pocket expenses, and fighting wrongfully denied claims.

Whatever the reasons, it's clear that those being wronged by these large insurance payers are fighting back, and it's about time. For too long, quality patient care and declining physician reimbursement have taken the back seat to large profits for the insurance companies. On a website I follow, called seekingalpha.com, you can read about every publicly traded insurance company, specifically all of their earnings and future merger plans, to make more money at your expense.

Recently, some government agencies have started stepping in to put a halt to these wrongdoings, but I'm afraid these insurance companies have been operating under the radar for so long, that it will take years to clean these issues up.

What I do know, is that physicians and patients are starting to send a clear message to these insurance companies and the decision makers behind the desk. It's that they will prevail, and there is truly strength in numbers.

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© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health