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Health Maintenance Organizations may be charging excessive co-pays to consumers for medical services rendered.

Click here if you have had similar experiences as those affected by this investigation.

Investigation Source

Carey & Danis, LLC

8235 Forsyth Blvd.
Suite 1100
St. Louis, MO 63105

Investigation Scope

Nationwide

Category Information

Investigation Topics

Misrepresentation
Over Charge
Excessive or Unauthorized Fees

Product or Service

Co-Pay For HMO Health Insurance

Injury Type

Monetary Loss

Investigation Details

This is a broad investigation into the billing practices of certain Health Maintenance Organizations ('HMOs') in several states, including Missouri, Illinois, Texas, Oklahoma and Michigan.

Consumers have reported that they have been charged co-pays that are excessive in comparison to the services provided over the course of the last 5 to 10 years.

If you are a member of an HMO, and have paid a co-pay for any treatment or medication, we would like to talk to you. We would also like to review the EOB (Explanation of Benefits) provided to you by your HMO with respect to any of the treatment or medications you received. We believe that the overcharges at issue occur most frequently in association with treatment by chiropractors, so if you have received chiropractic treatment (and/or prescription medication) and are an HMO member, please visit our web site.

Below is a list of HMOs in Missouri alone that we believe may be engaging in this practice: AETNA HEALTH INC; ALLIANCE FOR COMMUNITY HEALTH LLC D/B/A MERCY CAREPLUS; BLUE CROSS AND BLUE SHIELD OF KANSAS CITY; BLUE-ADVANTAGE PLUS OF KANSAS CITY INC D/B/A BLUE-ADVANTAGE; CHILDRENS MERCYS FAMILY HEALTH PARTNERS INC; CIGNA HEALTHCARE OF OHIO INC D/B/A CIGNA HEALTHCARE OF KANSAS; CIGNA HEALTHCARE OF ST LOUIS INC; COMMUNITY HEALTH PLAN; COVENTRY HEALTH CARE OF KANSAS INC; COX HEALTH SYSTEMS HMO INC; ESSENCE LLP; GOOD HEALTH HMO INC DBA BLUE-CARE INC; GROUP HEALTH PLAN INC; HARMONY HEALTH PLAN OF ILLINOIS INC; HEALTHCARE USA OF MISSOURI LLC; HEALTHLINK HMO INC DBA HEALTHLINK HMO; HMO MISSOURI INC DBA ANTHEM BLUE CROSS AND BLUE SHIELD; HUMANA HEALTH PLAN INC; MERCY HEALTH PLAN OF MISSOURI INC D/B/A PREMIER HEALTH PLANS; MERCY MC + INC; MISSOURI CARE INC INCORPORATED; UNITED HEALTHCARE OF THE MIDWEST INC; AETNA US HEALTHCARE OF ILLINOIS INC; AMERICAID ILLINOIS INC; BCI HMO INC; BENCHMARK HEALTH INSURANCE COMPANY; CIGNA HEALTHCARE OF ILLINOIS INC; CIGNA HEALTHCARE OF ST. LOUIS INC; COMMUNITY HEALTH PLAN OF SBL INS CO; GROUP HEALTH PLAN INC; HARMONY HEALTH PLAN OF ILLINOIS INC; HEALTH ALLIANCE MEDICAL PLANS INC; HEALTH CARE SERVICE CORP MUT LEG RES CO; HEALTH LINK HMO INC; HEALTH PARTNERS OF THE MIDWEST; HMO MISSOURI INC; HUMANA HEALTH PLAN INC; HUMANA HEALTHCHICAGO INC; JOHN DEERE HEALTH PLAN INC; MEDICAL ASSOCIATES HEALTH PLAN INC; MERCY HEALTH PLANS OF MISSOURI INC; ONE HEALTH PLAN OF ILLINOIS INC; OSF HEALTH PLANS INC; PERSONALCARE INSURANCE OF ILLINOIS INC; PRUDENTIAL HEALTH CARE PLAN INC; ROCKFORD HEALTH PLANS INC; RUSH PRUDENTIAL HMO INC; UIHMO INC; UNITED HEALTHCARE OF ILLINOIS INC; UNITED HEALTHCARE OF THE MIDWEST INC; UNITY HMO OF ILLINOIS INC.

Defendant Details

Name (Stock Symbol)	Brief Description
Aetna Health Inc.	Aetna is a large provider of health care, dental, pharmacy, group life, and disability insurance, and employee benefits. Aetna is the brand name for products and services provided by one or more of the Aetna group of subsidiary companies. One such subsidiary is Aetna Health Inc.
Alliance for Community Health LLC	Alliance For Community Health LLC was a HMO that served Medicaid-eligible people in Missouri. It served approximately 38,000 Medicaid recipients in St. Louis City and 9 surrounding counties. Its network of participating healthcare partners includes 19 hospitals, 3,500 physicians and 110 ancillary providers. In 2006, Alliance For Community Health LLC merged with Mercy Careplus. In 2007, Molina Healthcare (NYSE:MOL) acquired this combined entity.
Blue Cross Blue Shield Of Kansas City	Blue Cross and Blue Shield of Kansas City is a health insurance company, providing health coverage for more than 880,000 members in 32 counties in greater Kansas City, Missouri.
Childrens Mercy Family Health Partners	Childrens Mercy Family Health Partners provides low-cost or no-cost health insurance in Kansas.
Cigna Healthcare of Kansas	Cigna Healthcare of Kansas is a DBA for Cigna Healthcare of Ohio, which is a subsidiary of Cigna. Cigna Healthcare of Kansas provides health insuance plans and is an HMO.
Cigna Healthcare Of St Louis Inc.	Cigna Healthcare Of St Louis Inc. is a HMO operating in Missouri. It is a subsidiary of Cigna Corporation.
Community Health Plans	Community Health Plans is a WAshington based HMO.
Coventry Health Care, Inc. (CVH)	Coventry Health Care, Inc. offers health insurance plans.
Cox Healthplans LLC	Cox Healthplans LLC is a HMO operating in Southwest Missouri.
Essence LLP	Essence LLP does business as Essence Healthcare and appears to offer a health insurance plan called Essence Advantage, which provides prescription cost coverage for those consumers already on Medicare.
Harmony Health Plan	Harmony Health Plan is a licensed Illinois health maintenance organization. It is owned by Wellcare.
HealthCare USA Of Missouri LLC	HealthCare USA Of Missouri LLC is a wholly-owned unit of Coventry Health Care Inc.
HMO Missouri Inc. dba Anthem Blue Cross and Blue Shield	HMO Missouri Inc. dba Anthem Blue Cross and Blue Shield is a HMO.
Humana Inc. (HUM)	Humana Inc. provides various health and supplemental benefit plans for employer groups, government benefit programs, and individuals in the United States
United HealthCare of the Midwest	United HealthCare of the Midwest, a subsidiary of UnitedHealth Group, provides health insurance products and related services to members in Illinois, Missouri, and Kansas through a network of physicians and hospitals. United Healthcare of the Midwest is also one of the largest Medicaid HMOs in the US, providing coverage to over 75,000 beneficiaries.
Aetna US Healthcare of Illinois Inc.	Aetna is a large provider of health care, dental, pharmacy, group life, and disability insurance, and employee benefits. Aetna is the brand name for products and services provided by one or more of the Aetna group of subsidiary companies. One such subsidiary is Aetna US Healthcare of Illinois Inc.
BCI HMO Inc.	BCI HMO Inc. is an affiliate of BlueCross BlueShield of Illinois. BCI HMO Inc. is an HMO.
Benchmark Health Insurance Company	Benchmark Health Insurance Company, a subsidiary of UnitedHealthcare, is an HMO.
Cigna Healthcare Of Illinois Inc.	Cigna Healthcare Of Illinois Inc. operates a HMO in Illinois and is owned by Cigna Corporation.
Health Alliance Medical Plans, Inc.	Health Alliance Medical Plans, Inc. provides health insurance services in the United States. The company provides health care coverage through various health care plans, including individual plans and Medicare plans, as well as group plans that include HMO plans, plus plans, POS plans, PPO plans, TPA plans, coordinated care plans (CCP), flexible spending accounts, and health reimbursement arrangements. Health Alliance Medical Plans was formerly known as CarleCare, Inc. Health Alliance Medical Plans, Inc. operates as a subsidiary of Carle Clinic Association Pc.
John Deere Health Plan, Inc.	John Deere Health Plan, Inc was an HMO but was sold to UnitedHealthcare.
Medical Associates Health Plans	Medical Associates Health Plans offers administrative services to employers who self-fund their health insurance through its affiliated company, Health Choices.
Mercy Health Plans of Missouri Inc.	Mercy Health Plans of Missouri Inc., a subsidiary of Mercy Health Plans, is a St. Louis-based health benefits management company.
OSF HealthPlans	OSF HealthPlans is a HMO in Illinois.
Personalcare Insurance of Illinois Inc.	Personalcare Insurance of Illinois Inc., a subsidiary of Coventry Healthcare, provides health insurance.
Prudential Health Care Plan Inc.	Prudential Health Care Plan Inc. is a subsidiary of Prudential.
University of Illinois HMO, Inc	University of Illinois HMO, Inc. is a HMO.
United Healthcare of Illinois	United Healthcare of Illinois, a subsidiary of UnitedHealth Group, provides health insurance products and related services for customers in areas of Illinois not covered by United Healthcare of the Midwest (mainly in the Chicagoland area).

Click here if you have had similar experiences as those affected by this investigation.

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