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Illegitimate UCR Rate Reductions Apply to All Types of Out-of-Network Medical Providers

The Ingenix database products, investigated by the New York Attorney General's office, were reported in Congressional hearings to be used by insurance companies throughout the country. From our experience, insurance companies who use UCR cost containment software typically gain use of the software through a medical bill review firm, also called a bill re-pricing company. These re-pricing companies typically enter the information on the face of a medical provider's bill into a software program that checks codes and prices against the data contained in the UCR software system used by that re-pricing company. When a UCR reduction is applied to your bill, the bill re-pricing company usually gets paid a percentage of the savings it created for the insurance company. The bill re-pricing companies track the UCR reductions because the reductions form the basis for their payment. Bill re-pricing companies typically have the technology to track reductions by each medical provider's tax identification number or other practice specific information and can determine through their software the aggregate amount of reductions applied to your practice over a given number of years.

In addition to hospitals and medical practices, podiatrists, psychologists, chiropractors and physical therapists are all entitled to challenge UCR reductions based on faulty data. Phillips & Garcia has handled individual and class action claims against insurance companies and bill re-pricing companies and knows what information to obtain to establish the aggregate amount of discounts taken on your bills. Contact us today and ask us to explain in detail how UCR reductions work.

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