Today brings the last of a long string of Andrew Cuomo announcements about insurers agreeing to change the way they calculate payments for people who get health care from out-of-network providers. In what the New York attorney general called the “final agreement” in the series, the insurer Health Net has agreed to stop using UnitedHealth’s Ingenix database for used to calculate “reasonable and customary” fees for out-of-network payments. The company also agreed to contribute $1.6 million toward the creation of a new database. Cuomo’ has been at this for a while now, announcing a string of these agreements over the past several months. The larger deals included UnitedHealth, which agreed

to contribute $50 million toward a new, independent database that will replace Ingenix’s; Aetna, which agreed to contribute $20 million; and Cigna and WellPoint which agreed to contribute $10 million each. Cuomo says that the Ingenix database led to payments that were too low. UnitedHealth didn’t admit wrongdoing, and when CEO Stephen Hemsley testified before the Senate Commerce Committee, he defended the database . “The committee knows better than most that physician reimbursement based on nothing but the doctor’s bill is simply not economically tenable for consumers nor our health care system,” he said.

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Insurers, Out-of-Network Payments and the New York AG