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Health Insurers' Bad UCR Rate Data on Out-of Network Claims Subject to Liability

You may have read about the recent "buzz" about health care insurance company UCR rate reductions on "out-of-network" bills. Attorney General Cuomo of New York investigated insurance company tactics of using the Ingenix UCR database to apply steep UCR rate reductions on out-of-network medical bills. Apparently, consumers and providers were complaining about low insurance company reimbursements on out-of-network bills. Cuomo's investigation lead to a report concluding that Ingenix had a conflict of interest because it was a unit of United Healthcare Group, the parent company of United Healthcare, one of the biggest health insurers in the country. The proverbial fox guarding the chicken coop. The UCR rate reimbursement problem is not a new issue. We filed cases on this issue in 1998.

Medical providers have a great opportunity in front of them to be reimbursed for all of the monies they were shorted by UCR rate reductions on out-of-network bills. Insurance companies who used the Ingenix database are now subject to liability for improperly reducing medical benefits for their insureds. Depending on the size of your practice, improper UCR reductions could add up to hundreds of thousands of dollars in potential revenue.

Request a copy of our newest provider educational tool: "How to Get Paid UCR Rate Reductions on Out-of-Network Bills." In this guide we will explain how a retrospective audit of your out-of-network reimbursements could lead to reimbursements for all improper UCR rate reductions and increase your bottom line by accessing what you thought was a "lost revenue" stream.

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