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December 27, 2006 at 01:01 PM
The New Jersey Division of Insurance wants to free health carriers from having to rely on health care price data supplied by a unit of UnitedHealth Group Inc.
New Jersey insurance regulators have proposed a change in insurance regulations, in Proposal Number 2006-405, that would let carriers use price data from the federal government rather than from the UnitedHealth unit when determining benefit amounts for patients’ visits to out-of-network doctors, clinics and testing facilities.
Up till now, most Garden State health carriers have based reimbursement for claims for care from out-of-network “non-hospital providers” on Prevailing Healthcare Charges System price data.
The price figures come from Ingenix, Eden Prairie, Minn., a unit of UnitedHealth, Minnetonka, Minn.
Today, many health carriers in New Jersey are using or want to use the Resource Based Relative Value Scale data collected by the Centers for Medicare and Medicaid Services, New Jersey officials write in the administration change proposal.
One problem, for patients and out-of-network doctors, is that the RBRVS fees tend to be much lower than the PHCS fees, officials write.
