More plans settle over Ingenix database use

Two insurers agree to reimburse members and physicians for out-of-network claims that were underpaid over the last six years.

By Emily Berry — Posted March 25, 2009

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Three New York insurance companies in March became the latest to promise to reform the way they determine what they pay for out-of-network care.

Excellus Health Plan and Capital District Physicians' Health Plan on March 5 reached deals with New York Attorney General Andrew Cuomo promising to stop using databases owned by UnitedHealth Group subsidiary Ingenix as the basis for out-of-network reimbursement rates.

Excellus agreed to pay $775,000, and CDPHP pledged $300,000 toward a new independent database.

Also, New York-based Guardian Life Insurance signed a deal with the attorney general's office the same week and agreed to contribute $500,000 to the new database.

That makes 10 insurers that have agreed to stop using Ingenix in favor of a new database. None of the companies have admitted any wrongdoing. They have promised a combined $93 million toward a new, nonprofit independent database.

Cuomo accused the plans of using what he called a flawed database to underpay for out-of-network care.

"Removing the cloak of secrecy from the Ingenix database has triggered a domino effect among health insurers that promises to benefit patients and physicians by reforming the corrupt system for paying out-of-network medical bills," American Medical Association President Nancy Nielsen, MD, PhD, said in a statement.

Also, Excellus, based in Rochester, and CDPHP, based in Albany, have agreed to recalculate and repay claims that were underreimbursed over the last six years. The amount they will pay is being determined.

United is the only other plan to offer back payment regarding Ingenix. In January, as it settled with Cuomo, it also settled a longstanding federal lawsuit with the AMA and state medical associations over its role as owner and administrator of the Ingenix databases. Once court approval is granted, United would offer $350 million in payments to physicians who were paid too little for out-of-network care.

The AMA and numerous state societies in February filed lawsuits against Aetna and Cigna seeking similar restitution. Aetna and Cigna have denied any wrongdoing.

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