Editorial Calls for Senate Committee’s Involvement in Expanding System To Determine Out-Of-Network Doctor Payments
"All insurers should enable customers to determine, in advance, how much they will have to pay for services outside their network," a New York Times editorial states. The health insurance industry's method of determining how to pay out-of-network providers looks like it has "been manipulated to shortchange patients by hundreds of millions of dollars over the past decade," the editorial adds. Two recent Senate Commerce, Science and Transportation Committee hearings "were a useful reminder of how badly the industry behaved in using" UnitedHealth Group subsidiary Ingenix to determine doctor payments, according to the Times.
According to the Times, the "tough" settlement negotiated by New York state Attorney General Andrew Cuomo (D) with UnitedHealth "will clean up much of the mess" both in New York and other states. While it did not admit any wrongdoing, UnitedHealth will pay $350 million to settle the charges and has agreed to allow an independent not-for-profit group to determine the doctor payments. Eleven additional insurers will help finance the new payment database.
Despite the settlement, "there are loose ends that need attention" because the agreement "won't reach all insurers in all states," the editorial says. The Senate Commerce, Science and Transportation Committee "will need to explore what further steps may be required to force insurers to use either the new database or some other measure that is reliable and free of conflicts of interest," according to the Times (New York Times, 4/8).