Woman Gets $375,000 Insurance Check; “It’s Like Winning The Lottery!”

How it works: insurance co. sending massive checks to patients 

| Lawsuit claims mega payouts to consumers put pressure on providers to join networks

| Kaiser Health News – The lawsuit highlights part of an ongoing war between insurance companies and providers over payment and billing issues, one that puts the patient right in the middle of the fight by sending payments straight to patients after they seek out-of-network care …

Insurer Skips Doctors, Sends Massive Checks To Patients

CNN – A woman received nearly $375,000 from her insurance company over several months for treatment she received at a California rehabilitation facility.

A man received more than $130,000 after he sent his fiancée’s daughter for substance abuse treatment.

Those allegations are part of a lawsuit winding its way through federal court that accuses Anthem and its Blue Cross entities of paying patients directly in an effort to put pressure on health care providers to join their network and to accept lower payments.

The insurance giant is accused of sending more than $1.3 million in payments to patients — money, the suit claims, that is owed to the facilities that treated people with addiction and mental health problems.

The suit by Sovereign Health highlights part of an ongoing war between insurance companies and providers over payment and billing issues, one that puts the patient right in the middle of the fighting by sending payments straight to patients after they seek out-of-network care.

Is it okay to keep the money?

Patients are supposed to send the money on to providers. Many times, they do; other times, they don’t.

Critics say it’s a revenge tactic against doctors, hospitals, treatment facilities and other medical providers that don’t agree to insurance companies’ demands to be “in-network,” by making them chase down money. The insurance industry disputes any such characterization.

Regardless of who and what is to blame, Arthur Caplan, the director of medical ethics for New York University’s School of Medicine, called the idea of insurers sending money to patients “insane.”

“My overall, moral reaction is: Are you kidding me?” he said of the notion of paying patients.”It’s almost like winning the lottery, it seems to me. So, I’m not surprised that there are misuses — and I’m enormously surprised that anyone would think this is a doable approach.

“Only in our crazy, market-driven, bureaucratic mess of a system,” Caplan added, “would we think about this kind of a solution.” Read more.

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