National database will show consumers their out-of-network costs

An independent database is in the works that will enable consumers to compare out-of-network prices before choosing their doctors.

It will be developed by a newly created not-for-profit company, FAIR Health, Inc., and a research network headquartered at Syracuse University, New York Attorney General Andrew Cuomo announced Oct. 27.

The move stems from a settlement reached over the past year with more than a dozen insurance companies regarding one of the industry's most controversial practices: the payment of out-of-network claims.

Using a database run by UnitedHealth Group's Ingenix subsidiary, the industry was accused of systematically understating physician's fees for more than 10 years and shortchanging consumers by hundreds of millions of dollars.

Consumers' reimbursements "will actually go up now because the reimbursements were artificially deflated," said Cuomo, whose office investigated the issue and found that the database intentionally skewed "usual and customary" rates downward through faulty data collection, poor pooling procedures, and the lack of audits. This forced consumers to pay more than they should have. 

The database will be funded with nearly $100 million in settlement money recovered during Cuomo's investigation. 

To learn more:
- read the press release
- check out this New York Times article

Related stories:
Ingenix database to be shut down
Ingenix database faces federal going-over
Study: Ingenix data used throughout health plan industry ...

Suggested Articles

A select few legacy health organizations could thrive under a ‘Medicare for All’ system, according to a new analysis. 

The Congressional Budget Office estimates a Senate package tackling surprise billing and drug prices will save the government $7 billion.

Mahmee, a startup focused on maternal and infant health, just closed a $3 million funding round that includes Mark Cuban and Serena Williams.