Falling in Love -- with Andrew Cuomo

I was never even a fan. Actually, in the way many great romances begin, I couldn't stand him. He struck me as arrogant and entitled. But I'm beginning to think I was wrong.

The other day, Andrew Cuomo, the Attorney General of New York, ventured where no man dare tread. He decided to take on the health insurance industry. Their scams are well known to every one of us. There's not a human being alive, privileged to pay choking amounts for all but worthless insurance, who won't relate to what you're about to read. And by the time you're finished, you too, may fall in love with Andrew.

The scam is something we--that's you and I--are all very familiar with. But the people we elect, who are supposed to police and regulate this notoriously corrupt and immoral industry, have consistently looked the other way. Until Andrew came along.

Whenever you go to a doctor and hand over your heavily over-subscribed credit card to pay a $200 or $300 bill, you know, you just know, you'll be lucky to collect anything even after a long wait and frequently a protracted fight. I for one, pay a fortune for health insurance known as a PPO (preferred provider organization), which gives me the right to see a doctor within the network, or, go outside the network. If I go outside the network, there is a huge financial disincentive. I must pay the doctor a steep fee directly on the spot, and then, hope to be reimbursed by the penurious insurance company. The operative word here is 'hope'.

But when I need to see a doctor outside the PPO, I do what we all do. I pay, then fill out a claim form, spend time copying my credit card receipt and mail the neat little package to my insurance company. Then I wait . . . and wait . . . and wait. Sometimes I consult the insurance company web site to see if a payment has been posted. Finally, after an almost endless wait, a payment pops up. It's supposed to be 80% of what is called the usual and customary charge. But it isn't. It's much less.

This is where my new love, Andrew Cuomo, comes in. Say I've met my deductible for the year, I visit an out-of-network doctor and pay a fee of $200. I'm entitled to receive a magnanimous $160 reimbursement--80% of the usual and customary charge. As you know, this rarely happens. That $200.00 doctor visit suddenly becomes a $110.00 doctor visit, and I'm stuck with a check for $104 not $160. The insurer has unilaterally decided that the usual and customary charge is not $200 but $88 and I'm defrauded--yes, defrauded out of my full payment. This is the usual and customary way insurance companies operate.

So Cuomo is suing some of the worst--UnitedHealth and others. Make no mistake, this way of "doing business" is how they all operate. But to make matters even more putrid, let me leave you with a looming question.

How are reasonable and customary rates set in the first place? It's a question that almost no one can answer--except a company called Igenix. Igenix is owned by UnitedHealth. You heard me, Igenix is owned by UnitedHealth. Igenix is also the company that is used by the industry to calculate usual and customary rates.

So what you have here is the health insurance industry version of Three Card Monte--but in this case people aren't just losing money, they're losing their lives.

As Andrew Cuomo said in the New York Times, "there is no disclosure, there's no transparency, there's no accountability."

Now you know why I'm falling in love with Andrew Cuomo.