At long last, New York State Attorney General Andrew Cuomo announced that "A new not-for-profit company, FAIR Health, Inc., and an upstate research network headquartered at Syracuse University will develop a new independent database for consumer reimbursement [of charges from out of network doctors] and a new website where for the first time consumers can compare prices before they choose their doctors." This new company will become responsible for managing the Ingenix databases that insurers use to calculate out of network plan allowances. The relatively low allowances calculated by the Ingenix databases encouraged health plan members to use in-network providers, a practice which controls health plan premiums. The new database will offer higher reimbursement levels which will disincent the use of network providers and generally increase premiums. It's not a good deal for consumers who follow the rules, but it's a great deal for out of network providers.
Business Insurance reports that "Fair Health will be fully implemented within one year and developed by five upstate New York universities." Fair Health has the right to modify the Ingenix database. It will be interesting to see whether Fair Health just decides to start from scratch because the Ingenix databases have become so vilified. If that latter route is followed, I expenct that full implementation will take more than one year.
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