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Matthew’s health care tidbits

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

In this week’s health care tidbits, a little bit of light was shone on two of the dirty tricks health insurers play. First San Diego is suing Molina, Centene (owner of Healthnet) & Kaiser for misleading patients about which providers are in their networks. Apparently Healthnet & Kaiser’s directories were 35% inaccurate and Molina 80%! Now this may be incompetence, but it is not only false advertising, it’s also a way of weeding out high cost patients who may leave when they can’t find a specialist that will take them–and of course avoiding a high cost patient is a nice earner for health plans.

The next trick is double billing. In this lawsuit unearthed by Bob Herman of Axios, Aetna which was being paid to manage an employer’s health network subbed out PT care to an Optum network. Optum then also charged an admin fee. Meaning the provider got less and the patient had to pay more. So while Aetna and United Healthgroup may appear to be fierce competitors, they’re happy to cooperate when it comes to ripping off their clients.

More bad behavior by health plans and I didn’t even mention them cheating on Medicare Advantage RAFs! But the CEO of Chenmed did.

If we are going to let health insurers profit from handling employer and taxpayer business, we should see those arrangements in the clear light of day. Time for some heavy handed Federal regulation, methinks.

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