Moda Health Fraudulent insurance practices Portland Oregon

MODA Health has decided, after having already paid the medical claims and considered them as being in network, to revist these paid claims (some dating back to 2014) and to no longer cover them, and to now consider the claims as being out of network and to decide that the price for the procedures exceeds the price that they MODA Health considers allowable for that proceedure (however they no where have a list of prices that they consider as acceptable prices). They also are requesting that the facilities/hospital reimburse them for the excess that they have paid.

In the new EOBS  they put all of the  financial responsibility on the patient and they take away any PPO discounts that they had previously allowed. They then decide not count all of the patient responsibility as part of the out of network care in the maximum out of pocket for out of network. According to MODA Health even when they say that they cover 50% of claims for out of network treatment, it is only 50% of the price that they consider is acceptable for the procedure.