Cuomo Battles Health Insurance Carriers and Posts a Victory for Consumers and Transparency

Cuomo Speaks Out on Victory

Back in February 2008 I reported NY Attorney General, Andrew Cuomo was investigating United Healthcare and has subpoenaed 16 other health plans including Aetna, CIGNA, Humana, and Well Point a subsidiary of Empire Blue Cross Blue Shield to determine how they calculate UCR. UCR is the usual customary and reasonable payment made for medical services rendered outside of the insurance carrier’s network.

Yesterday United Healthcare agreed to close down two Ingenix databases used to determine usual and customary payment rates for services for out of network doctors and pay 50 M to establish a new database that will be run by an independent nonprofit.  This much criticized database was run by Ingenix a subsidiary of United Healthcare. 

Cuomo’s investigation found that the UCR determined by Ingenix database for claims led to underpayments by iurers anywhere from 10 to 28 percent.   United wasn’t the only carrier using this database.

 

This is a huge victory for healthcare transparency for consumers. Under the agreement the new database will come with a web site that allows consumers to see how much they will be reimbursed for services in their area for out of network services

NY Attorney General Investigates Health Insurance Carriers

NY Attorney General, Andrew Cuomo is investigating United Healthcare and has suboenaed 16 other health plans including Aetna, CIGNA, Humana, and Well Point a subsidiary of Empire Blue Cross Blue Shield to determine how they calculate UCR. UCR is the usual customary and reasonable payment made for medical services rendered outside of the insurance carriers network.  We have all experienced the EOB that states the cost of your service exceeds what the insurance carrier determines to be usual and customary and your responsible for paying the diffrence. Finally NY AG has taken action to look at insurance carriers pratices to determine UCR  

Health Plan Week feature article on 2/28/07 read more click here.

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