Maryland Injury and Disability Law : Washington DC Metro Injury & Disability Lawyer & Attorney : Greenberg & Bederman : Accidents, Falls, Medical Malpractice : Maryland, DC, Virginia

Is getting ripped off “Usual” and “Customary?”

For the health care consumers all over the country, that has apparently been the case.

Back in January, New York Attorney General Anthony Cuomo pulled the plug on Ingenix, owner and operator of the biggest health care billing software in America.

The reason Ingenix was targeted by Mr. Cuomo was because of its billing practices when policyholders used out of network services. The “out of network” option is offered as a service on many health care policies, for which policy holders usually pay extra. If through choice or circumstance you found yourself using the services of a health care provider who isn’t affiliated with your health plan, the “out of network” option is supposed to cover somewhere in the neighborhood of 80% of the cost while you pay the rest.

But it didn’t work like that in real life. If the insurance companies simply said “Ok, you have a bill for $1000, we’ll pay $800 and you’ll pay $200,” Ingenix wouldn’t have had a reason to exist at all. Instead, Ingenix used its software to apply a sort of alchemy to its billing practices, with the end result being that policyholders who were using out of network services were being forced to pay way more than they should have. The rub in the software came in what was called the “Usual and Customary” rate, with “Usual and Customary” meaning the “average” costs for a given service.

• Email This
• Print
• Comments
• Trackbacks

The Tort System: It Stops Being “Broken” When It Starts Being You

For those of you are unaware of what tort reform means, it is a political movement whose proponents believe that our current judicial system is too easy for regular people to use. That probably isn’t the way that they would put it, but that’s essentially the centerpiece of the argument. They want caps on the sorts of damages that citizens can receive. They want restrictions on the sorts of lawsuits that people can file. They want severe restrictions on punitive damages. They want to do business in America without the crushing, stagnating, profit killing responsibilities of accountability towards the people who buy their products or use their services.

It isn’t very hard to put yourself in their shoes. The majority of the people involved in the tort reform movement have direct ties to insurance companies, pharmaceutical companies and product manufacturers. They often think of things in terms of profitability, and they probably view lawsuits as a problem that is to be solved, like improving efficiency or finding a cheaper supplier for parts. If you see everything in terms of a balance sheet, it’s hard to see actual human beings who have suffered real damages from the results of your business. Instead you think about the money you could be making if it weren’t for the insurance premiums and attorneys fees.

• Email This
• Print
• Comments
• Trackbacks

When Do I need A  Personal Injury Lawyer?

In the aftermath of an accident, it can be sometimes be difficult to know if you need a lawyer. Many accidents fall squarely in the “no harm, no foul” category, in that the damage to the property or persons of those involved is negligible. For instance, if the accident is a fender bender car accident with minimal property damage, you should be able to handle your damages through the insurance companies. Or if you slip and fall in a restaurant but don’t injure anything but your pride, there is no need to contact an attorney at all.

But the stakes change when the accident involves medical treatment. This is when the liability involves more money, and insurance companies often take steps to make sure that they pay out as little as possible.

There is often a drastic difference between what an injury victim should receive and what an insurance company is willing to pay. Having an attorney to represent your interests can be the difference between receiving fair treatment and not even receiving enough to cover your damages. What follows are some situations where you should contact a personal injury attorney as soon as possible.

• Email This
• Print
• Comments
• Trackbacks

Physician, Heal Thyself

As attorneys who represent the injured, we often find ourselves in direct opposition to insurance companies, tort reform organizations, and HMO’s.

There aren’t many subjects on which we agree. We believe that those who have been injured due to the incompetence or negligence of others deserve full compensation, and they believe that there should be strict limits on what sort of damages the injured can recover. We believe that the rights of Americans to access the court system should not be limited in any way, while some believe that sort of freedom is bad for business. We believe that the primary goal of an insurance company should be to honor the needs of their policyholders, while they treat the ill as though their needs come a distant second to honoring the needs of their stockholders.

There is, however, one subject upon which we do agree. Insurance companies, tort reform organizations and medical professionals believe that there is a real problem in this country involving medical malpractice. We believe that as well. But their contention is that the problem centers on the victims, while our position is that the problem comes from the doctors, nurses and medical professionals who don’t do their jobs properly.

If you take a look at your average tort reform web site, you will find page after page of reports and statistics that tell you about high insurance premiums, so-called “frivolous lawsuits,” and trial lawyers who are inevitably described as “greedy.” But you won’t find much about the actual doctors who are being sued.

Medical malpractice lawsuits happen for a reason. Perfectly healthy people don’t walk into our office and announce that they would like to sue their doctor. A medical malpractice lawsuit happens when there are real damages that come from real professional negligence by medical providers. So we find it strange that these organizations rarely acknowledge that doctors make preventable mistakes, that people suffer as a result, and that the medical system as currently designed by self enforcement allows some doctors with extremely shoddy records to keep practicing medicine. As far as we are concerned, that’s the heart of the medical malpractice “crisis.”

• Email This
• Print
• Comments
• Trackbacks

The Patient’s Bill of Rights

You are not simply a set of problems that need to be solved. You are a human being with rights.

This is the basic premise behind the Patient’s Bill of Rights, which was created in 1998 by the U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry.

This was an incredibly important development for patients (meaning ALL OF US,) in America. Prior to the creation of the Bill, there were no real rules in place for how the sick or injured should be treated, and the standard of care absolutely reflected that.

Patients were routinely chewed up and spit out by the HMO system, who to this day value profit margins over patient care. Patients weren’t adequately informed about their treatment and options, confidential patient information was guarded loosely if it was guarded at all, and patients requiring emergency services were financially penalized for not PRE-APPROVING them. And these were only some of the problems.

• Email This
• Print
• Comments
• Trackbacks