Again, we see, now the sixth in a line of health insurers admitting by this action that they knowingly used faulty data to deny, delay and prevent – in essence, defraud – patients and providers of payments. One can only hope that this type of action by the AG in New York will prompt health insurers to begin moving toward a fair system based on reasonable profit over costs (see “the plan” on this site). That would be a great step forward in helping to address payment inequities between and among carriers . . . jomaxx
WellPoint settles with New York over out-of-network reimbursement rates
New York Attorney General Andrew Cuomo said Wednesday that WellPoint Inc., the nation’s largest health insurer, will pay $10 million to help establish a new independent database to determine the rate it pays doctors and hospitals out of its network.” In doing so, WellPoint “becomes the sixth insurer to help fund the new database.” Cuomo has reached similar agreements with UnitedHealth, Aetna Inc., and Cigna Corp. WellPoint also agreed to no longer use a controversial database maintained by UnitedHealth Group Inc.’s Ingenix unit to determine the ‘usual and customary’ rate for out-of-network insurance reimbursements. The Ingenix database skewed downward the ‘usual and customary’ rates through faulty data collection, poor pooling procedures and lack of audits, thus forcing consumers to pay more out of their own pockets for healthcare.
According to Cuomo, the out-of-network cost to consumers dropped about 20 percent once Ingenix was removed from the mix. WellPoint Executive Vice President and Chief Executive Officer Ken Goulet stated that “the company ‘acknowledges the conflicts of interest in the Ingenix database.'” He added that the company supports Cuomo’s “efforts to increase the transparency of healthcare costs.
Meanwhile, American Medical Association President Dr. Nancy Nielsen urged all health insurers to reject the fatally flawed Ingenix database. And, although the new, independent database is a major step forward in reforming the health insurance industry, she noted that serious damages resulting from…prior use of the flawed Ingenix database still need to be addressed. The association is currently “involved in unsettled class-action lawsuits against Cigna and Aetna.
Read more @
WellPoint Will Fund Insurance Database – http://online.wsj.com/article/SB123497909811513833.html.html
Nation’s largest insurer WellPoint, Inc. agrees to $10 million settlement with the state, says Cuomo – http://www.nydailynews.com/ny_local/2009/02/18/2009-02-18_nations_largest_insurer_wellpoint_inc_ag.html
More Ingenix fallout: WellPoint will contribute – http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090218/REG/302189976
Another Insurer Drops Flawed Reimbursement Database – http://www.medpagetoday.com/PracticeManagement/Reimbursement/12940
Cuomo: Health insurers rigged out-of-network rates – http://www.newsday.com/news/local/ny-liinsu0219,0,2343028.story