Settlement could change out-of-network fee structure

February 5, 2009

An agreement between the state of New York and UnitedHealth Group may drastically affect out-of-network care reimbursement for you and your patients.

An agreement between the state of New York and UnitedHealth Group may drastically affect out-of-network care reimbursement for you and your patients.

Last month, New York Attorney General Andrew Cuomo announced a resolution between his office and UnitedHealth Group, which owns insurer UnitedHealthcare and Ingenix, a billing information company that collects and provides reimbursement information to health plans. Cuomo accused UnitedHealth of manipulating Ingenix's Prevailing Healthcare Charges System database so that the "usual and customary" fees for out-of-network care were, in some cases, 28 percent lower than the market reality.

As part of the agreement, UnitedHealth will invest $50 million to establish a not-for-profit organization that will independently build a database of out-of-network fees from doctors and create a free, web-based resource where UnitedHealth members can investigate fees.