Banner
  • Revenue Cycle Management
  • COVID-19
  • Reimbursement
  • Diabetes Awareness Month
  • Risk Management
  • Patient Retention
  • Staffing
  • Medical Economics® 100th Anniversary
  • Coding and documentation
  • Business of Endocrinology
  • Telehealth
  • Physicians Financial News
  • Cybersecurity
  • Cardiovascular Clinical Consult
  • Locum Tenens, brought to you by LocumLife®
  • Weight Management
  • Business of Women's Health
  • Practice Efficiency
  • Finance and Wealth
  • EHRs
  • Remote Patient Monitoring
  • Sponsored Webinars
  • Medical Technology
  • Billing and collections
  • Acute Pain Management
  • Exclusive Content
  • Value-based Care
  • Business of Pediatrics
  • Concierge Medicine 2.0 by Castle Connolly Private Health Partners
  • Practice Growth
  • Concierge Medicine
  • Business of Cardiology
  • Implementing the Topcon Ocular Telehealth Platform
  • Malpractice
  • Influenza
  • Sexual Health
  • Chronic Conditions
  • Technology
  • Legal and Policy
  • Money
  • Opinion
  • Vaccines
  • Practice Management
  • Patient Relations
  • Careers

Settlement could change out-of-network fee structure

Article

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.

Related Videos