Flickr: kubatica

by Dr Miriam Carasa EdD, RN, CNA

Our NY Attorney General Andrew Cuomo announced this week a nationwide reform of the consumer reimbursement system for “out of network” health care charges. This significant achievement is the result of  Attorney General Cuomo’s healthcare reform investigation into the  database that was used by insurers nationwide to set reimbursement rates when patients went out of network for health services. This investigation discovered that  the Ingenix database used to set the rates for out of network reimbursement is owned by  one of the largest insurers in the nation. Conflict of interest or coincidence?

Flickr: The Third Estate Sunday Review

The investigation uncovered that the “ usual and customary” rates set by Ingenix were set in such a way that the consumers were forced to pay more than they should have. The rates were set low , so companies could underpay patients for out of network services.

Thanks to Attorney General Cuomo, this deplorable situation will very soon become a thing of the past. Beginning in January every national and regional health insurer operating in New York state will end their use of the Ingenix database and instead will have to use a new independent database.

This new , and independent data base will be created by a not for profit research network headquartered at Syracuse University, also designed as part of Attorney General Cuomo reform plan. The independent database will also have a website where for the first time the people of New York will be able to compare prices before choosing their doctors.

As a health care consumer and a proud member of the baby boomers  I am delighted with the news.

Thank you Attorney General Cuomo!