New Jersey’s health plan for school employees pays out-of-network providers virtually whatever they want.
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The Big Story
Thu. Dec 19, 2019
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What Happens When a Health Plan Has No Limits? An Acupuncturist Earns $677 a Session.
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New Jersey’s health plan for school employees pays out-of-network providers virtually whatever they want. Dozens of acupuncturists and physical therapists earned more than $200,000 in 2018 from school staff alone. One brought in $1 million.
by Marshall Allen
View Story
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More From This Investigation
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How One Employer Stuck a New Mom With an $898,984 Bill for Her Premature Baby
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Dignity Health said its employee, an ER nurse, failed to meet the deadline to add her premature newborn to its health plan, so she was responsible for the medical bills. It rejected her appeals for a year until ProPublica called.
by Marshall Allen
View Story
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How to Make Health Insurers Take Fraud Seriously
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Experts say both employers and working Americans end up paying more when health insurance companies don’t report fraud to regulators and prosecutors.
by Marshall Allen
View Story
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Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You.
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Health insurers are regarded as fierce defenders of health care dollars. But the case of David Williams shows one reason America’s health care costs continue to rise. The personal trainer spent years posing as a doctor and billing the nation’s top insurers, making off with millions.
by Marshall Allen
View Story
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What Can Be Done Right Now to Stop a Basic Source of Health Care Fraud
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Fraud is one reason we all pay so much for health care. But there are simple fixes that would make it more difficult for scammers to operate.
by Marshall Allen
View Story
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Behind the Scenes, Health Insurers Use Cash and Gifts to Sway Which Benefits Employers Choose
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The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.
by Marshall Allen
View Story
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Your Medical Devices Are Not Keeping Your Health Data to Themselves
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CPAP units, heart monitors, blood glucose meters and lifestyle apps generate information that can be used in ways patients don’t necessarily expect. It can be sold for advertising or even shared with insurers, who may use it to deny reimbursement.
by Derek Kravitz and Marshall Allen
View Story
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You Snooze, You Lose: Insurers Make The Old Adage Literally True
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Millions of sleep apnea patients rely on CPAP breathing machines to get a good night’s rest. Health insurers use a variety of tactics, including surveillance, to make patients bear the costs. Experts say it’s part of the insurance industry playbook.
by Marshall Allen
View Story
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Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates
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Without any public scrutiny, insurers and data brokers are predicting your health costs based on data about things like race, marital status, how much TV you watch, whether you pay your bills on time or even buy plus-size clothing.
Marshall Allen
View Story
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Why Your Health Insurer Doesn’t Care About Your Big Bills
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Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority. Just ask Michael Frank.
by Marshall Allen
View Story
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