Oct 28 2009
A new database operated by a New York nonprofit will help insurers determine their rates for out-of-network care and give consumers a heads-up on what to expect their policy to pay when they seek such care, the
New York Times reports. The program, which will be operated by the new nonprofit FAIR Health with support from Syracuse University and other states universities, was announced Tuesday by New York Attorney General Andrew Cuomo, whose office investigated the insurance industry's existing out-of-network pricing system (Abelson, 10/27).
The old database was operated by UnitedHealth, and Cuomo's investigation was prompted by complaints that it routinely caused insurers to shortchange physicians, leaving patients to foot more of the bills, the
Minneapolis Star Tribune reports. Cuomo's inquiries led to a settlement with insurers that requires them to put up $100 million to fund the new project. UnitedHealth chipped in $50 million for the project; the other $50 million was shared between other major insurers (Yee, 10/27).
Cuomo said that the new database "will bring much-needed transparency, accountability and fairness to a broken consumer reimbursement system," according to the
Associated Press. "Before you leave your house you will be able to look up the exact procedure you're going to have and you will know what the cost is, so when you get to the doctor's office, there will be no surprises for you or the doctor." Insurers lauded that change, saying it would "shed light on the exorbitant prices that out-of-network providers are charging" (Kates, 10/27).
The development comes amid a broader trend towards greater transparency in health care pricing, especially through Internet resources. "It's long been hard for health-care consumers to learn how much doctor visits or hospital stays will cost them. That's now beginning to change, as a growing array of Web sites try to lift the veil on pricing," the
Wall Street Journal reports. Doctors and hospitals have traditionally declined to publicize how much they are paid for their services, but consumers have become more cost-conscious as health care costs rise (Mathews, 10/28).
 This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
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