Georgia insurance commissioner launches inquiry into out-of-network payments

Georgia Insurance Commissioner John Oxendine (R) has ordered 18 insurers that operate in Georgia to report how they establish reimbursement rates for out-of-network services, the Atlanta Journal-Constitution reports.

Oxendine said he also is seeking information about whether any of the insurers use the Ingenix database that has been at the center of a series of lawsuits alleging that data were manipulated to underpay out-of-network physicians. Ingenix is a unit of UnitedHealth Group. Oxendine on Thursday said that insurers must pay out-of-network rates to providers that are considered usual, customary and reasonable for a particular community. He added, "We are getting some complaints" that when providers are underpaid by insurers, costs are shifted to patients.

The inquiry comes less than two weeks after the Medical Association of Georgia joined the American Medical Association in filing a class-action lawsuit against WellPoint. According to the lawsuit, the insurer colluded with Ingenix to underpay providers for out-of-network services, which resulted in patients paying too-high medical bills. UnitedHealth earlier this year said it would pay $350 million to settle an AMA lawsuit over similar issues of price-fixing and out-of-network claims, while similar lawsuits have been filed against Aetna and CIGNA (Miller, Atlanta Journal-Constitution, 4/2).