Expanding access to health insurance may not help much if insurers reimburse doctors at unrealistically low rates.
Lawmakers and representatives from Consumers Union, Yonkers, N.Y., and the New York state attorney general's office made that case last week at a hearing organized by the Senate Commerce, Science and Transportation Committee.
Today, Stephen Helmsley, president of UnitedHealth Group Inc., Minnetonka, Minn., and Andy Slavitt, chief executive officer of UnitedHealth's Ingenix health data unit, followed up at a second, related hearing by rebutting allegations that Ingenix has intentionally skewed pricing data.
Linda Lacewell appeared last week on behalf of the New York state atorney general's office, which has negotiated a series of settlements in connection with allegations that health insurers have used distorted physician pricing data from Ingenix to depress reimbursement rates for out-of-network claims. The office is trying to use the settlement proceeds to set up a new, independent, nonprofit health pricing data organization that will be independent from the health insurers.
In the New York attorney general's office, "we believe there is a need for a new regulation to end once and for all the conflicts of interest that derailed the previous system and to bring new rigor to the system," Lacewell testified, according to a written version of her remarks. "First, insurers should not be permitted to use as a source or basis for determining usual and customary rate any entity that has a pecuniary interest in the rates. That includes any insurer, HMO, medical association, or health care provider."
Insurers also should base consumer reimbursements in this area on accurate schedules that fairly reflect the market and are regularly updated, and they should tell consumers ahead of time how much they will be reimbursed, Lacewell said.
Charles Bell, a programs director at Consumers Union, said the New York attorney general's office health care pricing investigation has "exposed a swamp of financial shenanigans."
Consumers Union wants to ensure that the new database for calculating out-of-network charges will be broadly used across the entire marketplace, Bell said.
Regulators should help by holding insurers companies accountable to their contractual promises, Bell said.
"If your policy says it will pay you 80% of the 'usual and customary' charge for a medical service, it should pay that amount," Bell testified, according to the written version of his testimony.
