Health Insurance Companies May Be Under Paying Claims

What happens if you are traveling and have to visit a hospital or doctor? Or what happens if you need to see a local doctor immediately who may not be in your health insurance company's “approved network of doctors?” You would expect your health insurance company to pay a reasonable amount towards those bills, wouldn’t you? But that doesn’t always happen.

Recent cases from across the country indicate health insurance companies may be significantly under paying out-of-network claims. This means consumers are unfairly left to pay the balance of these charges. In a recent Federal case, California based Health Net Inc. agreed to repay $215 million to its customers for using an out dated and lower than reasonable payment schedule for out-of-network claims. The company also agreed to spend $40 million to update its claims processing protocol to avoid this problem in the future.

DO YOU THINK YOU’VE BEEN THE VICTIM OF AN UNDERPAYMENT FOR AN OUT-OF-NETWORK CLAIM? Please call us or e-mail us at mcw2@moore-wolfe.com and put “underpayment” in the subject line. You may be entitled to a refund.