The data base will be run by a number of New York universities in New York, and a website will be developed so consumers will have an idea as to what the out of network charges will be instead of having a surprise element that we have seen over the years that paid physicians less and demanded more money from patients.
It looks like at least in one area we are going to have some algorithms that are not going to be proprietary. There are still a large number of law suits ongoing and being filed as a result of the use of the data base created by Ingenix, the technology subsidiary of United HealthCare.
The information in the new data base will also be available for academic research. BD
NEW YORK (Reuters) - New York Attorney General Andrew Cuomo announced on Tuesday the creation of a nationwide database to help set health care reimbursement rates, benefiting patients who use doctors outside their insurers' networks and capping an industry wide probe.
A new nonprofit, Fair Health Inc, will develop a database for consumer reimbursement, as well as a website where consumers will be able to compare prices before they choose doctors.
Calling prior reimbursement practices an "injustice" and "fraud," Cuomo said at a Syracuse, New York, press conference that Fair Health will "ensure transparency, accountability and fairness" for Americans who use out-of-network doctors.
Last year, Cuomo went after UnitedHealth, saying that since the database was owned by Ingenix, and Ingenix is a subsidiary of UnitedHealth, Ingenix had a vested interest in skewing rates low, so insurers could underpay doctors for out-of-network service. Through "faulty data collection, poor pooling procedures and the lack of audits," insurers underpaid by 10 to 28 percent for various medical services, Cuomo said.
Calling Ingenix a "black box," Cuomo said it created a conflict of interest because insurers were both providing and using the same data in calculating reimbursement rates.