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Not too long ago I posted about “claim scoring” and from what is said in this article, it could very well be the case. What is interesting is that the carriers they used “all” quit accepting the claims in 5 day period after all had paid claims for the same procedures until that point. Were...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Sep 2 2009
Filed under:
Filed under: Medically Related, Insurance, healthcare, Business Intelligence, Data Mining, Fines, Algorithms, formulas, United HealthCare, Inginex, overcharges, Ingenix, Senate Hearings, healthcare reform, Intelliscript
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Ingenix, the technology subsidiary of UnitedHealthCare had several other health insurance companies as paying clients who used their “business intelligence” software and algorithms to calculate out of network charges and some of those suits are just getting started. With so many carriers being...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Sat, Aug 8 2009
Filed under:
Filed under: Medically Related, Insurance, healthcare, Business Intelligence, Data Mining, Fines, Algorithms, formulas, United HealthCare, Inginex, overcharges, Ingenix, Senate Hearings, Intelliscript
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In a related story in Michigan, more people are losing their health insurance; however, profits are up for the HMOs . “Michigan health plans posted strong profits in 2008, despite seeing a 10 percent drop in commercial enrollment to 1.4 million, according to the 2009 Michigan Health Market...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Jul 22 2009
Filed under:
Filed under: Medically Related, Insurance, Fines, Algorithms, formulas, United HealthCare, Health Insurance Reserves, Inginex, overcharges, : Health Insurance
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This is a rather long but very informative “diary” written with both opinion and fact as to why our current health insurance plan is not working. Some of the facts mentioned that I found interesting was the budget of AARP for example which is 1 billion a year and 700 million of that is derived...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, Jun 8 2009
Filed under:
Filed under: Medically Related, Insurance, My Commentaries, healthcare, Business Intelligence, AMA, Data Mining, Fines, Algorithms, formulas, United HealthCare, Inginex, overcharges, Ingenix, Senate Hearings, Andrew Cuomo, Medpoint, Intelliscript
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It appears this is another solution for physicians to look at cost as it is business intelligence. Although the AMA had this to say on the topic: “Cohen also warns against paying for data from a source that isn't entirely transparent. Like many smaller health plans, some physician practices...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, May 4 2009
Filed under:
Filed under: Medically Related, Insurance, Other Items of Interest, health insurance, Balance Billing, Algorithms, formulas, United HealthCare, Ingenix, Texas, Fraud Against Practitioners, legislation, Penal Code, database mining, Rockefeller, Sutter
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The Ingenix Inquisition continues with efforts to find out if federal employees were also potential victims. We have laws for almost everything else you can think of out there, and algorithms determine about 95% of all business decisions today. Come to think of it, how about the algorithms...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Apr 22 2009
Filed under:
Filed under: Medically Related, Insurance, health insurance, Balance Billing, Algorithms, formulas, United HealthCare, Ingenix, Texas, Fraud Against Practitioners, legislation, Penal Code, database mining, Rockefeller
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It appears the investigation is going to phase 2, with a request to 20 other insurers to find out how they are using the data base. Recently the AMA filed a class action suit as well to investigate and find out as well. These are business intelligence data bases used to crank out the numbers...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Apr 2 2009
Filed under:
Filed under: Medically Related, Insurance, healthcare, Business Intelligence, AMA, Data Mining, Fines, Algorithms, formulas, United HealthCare, Inginex, overcharges, Ingenix, Senate Hearings, Andrew Cuomo, Medpoint, Intelliscript
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With the Ingenix story in the news the last few weeks, there are a couple of other data sources out there that are used to mine your medication and health records data. Part of the reason that is is all coming to light is due to the fact the data is now trying to be used in a constructive basis, for...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Sun, Mar 29 2009
Filed under:
Filed under: Medically Related, Insurance, healthcare, Business Intelligence, Blue Cross, AMA, Data Mining, Fines, MIB, Algorithms, formulas, Wellpoint, United HealthCare, Inginex, overcharges, Ingenix, Senate Hearings, Andrew Cuomo, Medpoint, Intelliscript
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This is perhaps the classic statement here: "You ask me how are their 'usual and customary' rates being determined?" Rockefeller said. "I don't know." It comes back to algorithms, formulas that determine the usual an customary fees. Anyone who had read...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Sun, Mar 29 2009
Filed under:
Filed under: Medically Related, Insurance, healthcare, Blue Cross, AMA, Fines, Algorithms, formulas, Wellpoint, United HealthCare, Inginex, overcharges, Ingenix, Senate Hearings, Andrew Cuomo
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If you have kept up here on the site of late, there’s been quite a bit posted about Ingenix. The related reading below will catch you up. What is Ingenix, health insurance business intelligence in short. This is why you may hear me talk and recommend business intelligence software...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Mar 26 2009
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, Blue Cross, AMA, Fines, Algorithms, formulas, Wellpoint, United HealthCare, Inginex, overcharges, Andrew Cuomo, California Nurses Association
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At some point in time we knew this had to arise. Can you blood from a stone? Right now with current economic conditions, people just can’t afford health insurance in many instances, food and rent come first. As I have mentioned before, Health Insurance companies invested heavily in...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, Mar 2 2009
Filed under:
Filed under: Medically Related, Insurance, Other Items of Interest, health insurance, Aetna, Fines, Algorithms, formulas, United HealthCare, Health Insurance Reserves, Inginex, overcharges, CEO compensation
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One more time I go back to the 2 hottest words in health care today: Algorithms and Whistleblowers, where the money seems to be: The 2 New Hot Words in Healthcare: Algorithms and Whistleblowers Both Wall Street and the Health Insurance Industry invested heavily with technology early on, and one...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Sat, Feb 28 2009
Filed under:
Filed under: Medically Related, Insurance, health insurance, Fines, Algorithms, formulas, United HealthCare, Health Insurance Reserves, Inginex, overcharges, CEO compensation
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I think every state could use an Andrew Cuomo. It is interesting now that Ingenix is gone that the industry still feels a need for such a tool. BD From his post as New York’s attorney general, Andrew Cuomo has become a one-man health-reform show. WellPoint, the nation’s largest health insurer...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Feb 18 2009
Filed under:
Filed under: Medically Related, Insurance, Other Items of Interest, AMA, Cigna, Fines, Algorithms, formulas, United HealthCare, Inginex, overcharges, HealtHealthCare, Adnrew Cuomo, The 2 New Hot Words in Healthcare: Algorithms and Whistleblowers Health Insurance
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This is an interesting article with new health cards, but leaves a few questions if you will. It states no information is stored on the card, thus does the card to go the website to find the individual patient information? Also it says the patient has to give permission, so how is that done, does the...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Feb 4 2009
Filed under:
Filed under: Medically Related, Insurance, health insurance, PHR, Fines, Algorithms, formulas, United HealthCare, Health Insurance Reserves, Inginex, overcharges, ID Cards
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One more state is continuing their investigation of United Healthcare and the use of Ingenix. Ingenix is set to close as part of the New York deal and the $50 million will go towards setting up a not for profit entity. Also, other insurance companies were using Ingenix too and the company...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Jan 15 2009
Filed under:
Filed under: Medically Related, Insurance, health insurance, Fines, Algorithms, formulas, United HealthCare, Health Insurance Reserves, Inginex, overcharges, Ingenix