Two New York State health insurers have agreed to end their use of a claims-processing data base that the state’s Attorney General alleged was defective and led to unfair out-of-network reimbursement rates for beneficiaries.
Under the agreement, Excellus Health Plan, Rochester, and Capital District’s Physician Health Plan, Syracuse, agreed to stop using the database, known as Ingenix, according to Attorney General Andrew M. Cuomo. They also agreed to reprocess claims made under the system and to reimburse state consumers who had paid an allegedly excessive share of health care costs out of their own pockets, Cuomo said.
The 2 companies will also contribute money to a qualified nonprofit organization that will establish a new, independent database, which the companies will use to help determine fair out-of-network reimbursement rates for consumers, the Attorney General announced. Excellus will pay $775,000 and CDPHP will pay $300,000 toward the new database. Excellus will also pay $775,000 to the Office of the Attorney General in costs and fees, Cuomo said.
Last month, Cuomo announced he had negotiated settlements with CIGNA, Philadelphia, and WellPoint, Indianapolis, over their use of Ingenix, a widely used out-of-network health reimbursement database owned by UnitedHealth Group Inc., Minnetonka, Minn., another health insurer.
Cuomo also recently announced similar agreements with UnitedHealth, Aetna Inc., Guardian Life Insurance Company of America, MVP Health Care/Preferred Care, Independent Health and HealthNow.