New York Attorney General Investigates Health Insurer Reimbursements |
|
|
Attorney General Cuomo has announced an investigation into whether health insurers systematically have required members to pay excessive fees for services performed by out-of-network health care providers. As part of the investigation, Cuomo plans to file a lawsuit against UnitedHealth Group and its’ subsidiary Ingenix. Cuomo also will file a civil lawsuit against three other UnitedHealth subsidiaries that seeks restitution for consumers. In addition, he has issued subpoenas to 16 other health insurers. The subpoenas seek documents on the processes that the health insurers use to determine reimbursement rates, copies of member complaints and appeals, and communications between members, Ingenix and health insurers. The New York AG plans to focus his investigation on the process that health insurers use to determine the portion of reimbursements for which they are responsible when members receive services from out-of-network providers. Health insurers pay for a certain percentage of the usual and customary rates for such services, based on an estimate of the cost for such procedures in the same geographic area. Ingenix operates the Prevailing Healthcare Charges System, a database used by most health insurers that determines the usual and customary rates. The database contains information on more than one billion claims from more than 100 health insurers. Health insurers compare out-of-network claims with those found in the database and reduce the claim to a "reasonable" amount before they reimburse providers or members. The New York AG alleges that health insurers have underestimated the usual and customary rates for services, a practice that requires members to pay larger out-of-pocket fees than they should pay. His investigation found problems with the estimates used to determine the usual and customary rates for services performed by out-of-network providers. In some cases, health insurers used outdated information to determine the estimate, and they manipulated data in other cases. The AMCNO has already met with the Ohio AG health insurer issues and the AMCNO has once again asked the Ohio AG for his comments on this latest investigation of health insurers by the New York Attorney General. To view the NY AG news release on this matter go to: |
|
|
|
|