Ingenix out-of-network payment data to be replaced

In January, New York Attorney General Andrew Cuomo decided that a database determining out-of-network rates for physicians was using numbers that were unfairly low. After investigating the matter, Cuomo demanded that Ingenix create a new database with more reasonable numbers.

Insurers in the state largely agreed to stop using the Ingenix database as soon as a new one was available, and put out a collective $100 million dollars or so to create a new one. A simplified version of the new database will be posted online, allowing doctors and patients to get a feel for rates they're willing to pay.

Now the new database, dubbed FAIR (Fair and Independent Research), is scheduled for a rollout. The nonprofit group running FAIR expects data to become available within one year. The nonprofit organization will be managed by Deborah Freund, PhD, distinguished professor of public administration and economics at Syracuse University in New York.

After all of this effort, surprisingly, Freund says she isn't sure that the new data will include substantially higher rates. (There's a serious hedge for you.) Meanwhile, America's Health Insurance Plans argues that the new data will most likely demonstrate that out-of-network physicians are overcharging for their services.

To learn more about this effort:
- read this American Medical News piece

Related Articles:
UnitedHealth's Ingenix faces mounting legal troubles
Ingenix database faces federal going-over
Study: Ingenix data used throughout health plan industry

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