Let’s blow this wide open: New York to reveal secret health insurance charges

Change is in the air for health insurance at the national level, but one state is not letting debate slow reform. In a monumental move, New York State Attorney General Andrew M. Cuomo announced in late October the formation of a new not-for-profit company, FAIR Health, Inc., to provide independent data to guide “usual, customary, and reasonable” (UCR) rates for out-of-network health charges.

This move eliminates UCR charge bias in New York’s health care system and allows consumers to research legitimate UCR rates in a simple, easy-to-understand format. Insurance companies had been using their own database of rates developed by Ingenix — owned by United Health Care — to determine UCR benchmarks. Ingenix was found to have biased rates downward at the behest of insurers, meaning the consumer was often reimbursed inadequately or charged incorrectly to begin with.

What does Cuomo’s action mean to you? If the trend of forcing insurers to contribute to independent UCR data extends to other states, you may finally be able to verify that reimbursements for out-of-network care are fair and accurate. You’d be able to shop around with more information in hand before choosing a provider.

If you live in New York and believe you have been overcharged or not reimbursed appropriately for out-of-network care, you can seek recourse with the New York Attorney General’s office.