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Health Insurance Investigation Nets 400 Million from Top Insurance Companies


Who comes up with insurance rates? How do they know what to charge? Who’s responsible for this mess, and how to you keep the system honest. Do you trust them to offer the lowest prices? Should we just believe they will do the right thing?

Florida health insurance web, a free health insurance information website has found details that should shock everyone who buys health insurance.

It seems over the last few years, insurance companies have been fixing health insurance rates. New York State’s Attorney General spent the last few years investigating several top-rated insurance companies which he believed were rigging or manipulating payments.

After this lengthy investigation, two of the top insurance companies, Aetna and United Healthcare, have agreed to pay nearly $400 million to fund independent research into claims rates databases.

Why would two huge health insurance companies pay millions of dollars to investigate themselves? The ’official story’ is not for release but it would seem New York Attorney General suggested, or may have ’forced’ them to do that, or something more unsavory.

Following the investigation UnitedHealth agreed to settle with New York State which claimed health insurers understated the portion of reimbursements for which they are responsible for such services by as much as 28% in some cases, or hundreds of millions of dollars over the last 10 years.

UnitedHealth admitted no liability in settling the three class-action lawsuits filed by physicians and health plan members over the payment database for out-of-network medical services. Under the agreement, UnitedHealth will pay ($50) million to finance the development of a new database that will be operated independently by a yet to be determined university.

Health insurance broker Morgan Moran ( )said, “With the creation of a new, independent database, consumers can now look forward to having more information, greater clarity and fundamental fairness in the out-of-network reimbursement system” [for whatever reason] “I’m glad United Health care stepped up to the plate in offering $350 million dollars to set up an independent firm for this research.”

Aetna, the third largest health insurer, agreed to pay $20 million dollars to a non-profit organization that will establish a new, ’independent database to help determine fair out-of-network reimbursement rates for consumers throughout the United States".

Currently, Ingenix, which is a subsidiary of UnitedHealth is operating the ’Prevailing Healthcare Charges System’ database contains information on more than one billion claims from more than 100 health insurers. They take that information and try to determine the “usual and customary rates” for a certain procedure.

Health insurers pay for a certain percentage of the usual rates for certain services, based on an estimate of the cost for such procedures in the same geographic area, this is used to help calculate the reimbursement an insurer then pays to providers or members. Moran said this type of system “gives Ingenix an incentive to manipulate the data so as to reduce reimbursement rates”

Find out more about the insurance settlement on


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