Monthly Archives: February 2008

More on Cuomo’s Investigation of Insurers

An editorial in the New York Times points out that the company used to estimate the cost of medical visits, estimates that are in turn used to determine the reimbursement of out-of-network benefits, is OWNED by one of the largest insurers in the US.  So, both the "estimators" and the insurers obviously have a vested interest in low-balling estimates, keeping profits high, and fudging the numbers, if necessary.   It's the same old corporate love story.  Does it really surprise us anymore?  Will a Democratic administration make an effort to clean these things up?  At least Cuomo is trying.

 –Suzanne Verderber 

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EVERYONE is invited to add his or her comments to any of these posts, whether or not you are a member of the Pratt Faculty Union.  All that you need to do is click on the log-in button below and follow the instructions.  The site should be driven by dialogue, not, as Russian literary theorist Mikhail Bakhtin would say, authoritarian monologism!  

–Suzanne Verderber  

Cuomo to Investigate Insurers, Including AETNA

The New York Times has reported that New York's Attorney General Andrew Cuomo is investigating several insurance companies, including AETNA, for underestimating the "reasonable" rate of medical charges when a patient uses an out-of-network provider.  Typically, in such cases (including my out-of-network plan) insurers pay 80% of what they determine to be the prevailing rate for a given service.  It is precisely this that Cuomo is charging is underestimated, requiring consumers to pick up much of the tab, in a climate in which these companies are making record profits.

 Here is the link .

 –Suzanne Verderber 

AETNA making decisions instead of doctors?

Who makes decisions on how to perform medical procedures, doctors or HMO's?  This piece about AETNA demonstrates that doctors have to fight the HMO's to have the power to make the right decisions for their patients.  Will this kind of situation ever be resolved unless this country takes the profit out of healthcare?

–Suzanne Verderber