New Jersey’s health plan for school employees pays out-of-network providers virtually whatever they want.
ProPublica Donate to ProPublica

The Big Story

Thu. Dec 19, 2019

What Happens When a Health Plan Has No Limits? An Acupuncturist Earns $677 a Session.

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.

   

More From This Investigation

How One Employer Stuck a New Mom With an $898,984 Bill for Her Premature Baby

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.

How to Make Health Insurers Take Fraud Seriously

Experts say both employers and working Americans end up paying more when health insurance companies don’t report fraud to regulators and prosecutors.

Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You.

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.

What Can Be Done Right Now to Stop a Basic Source of Health Care Fraud

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.

Behind the Scenes, Health Insurers Use Cash and Gifts to Sway Which Benefits Employers Choose

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.

Your Medical Devices Are Not Keeping Your Health Data to Themselves

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.

You Snooze, You Lose: Insurers Make The Old Adage Literally True

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.

Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates

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.

Why Your Health Insurer Doesn’t Care About Your Big Bills

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.

  Find us on Facebook Follow us on Twitter Follow us on Instagram Watch us on Youtube Donate to ProPublica