Ingenix, Inc. provides data used by most major health insurance companies to determine reimbursement rates for out-of-network medical expenses. After six-month investigation, it was revealed that Ingenix has been operating on a defective and manipulated database, by placing an artificially low reimbursement rates to patients. Under the United insurersÃ¢â‚¬â„¢ health plans, members pay a higher premium to have the option to use out-of-network doctors, while the insurers promise to cover up to 80% of either the doctorÃ¢â‚¬â„¢s full bill or of the Ã¢â‚¬Å“reasonable and customaryÃ¢â‚¬Â rate depending on which is cheaper. While United insurers knew most simple doctor visits estimate around $200, they claimed that Ã¢â‚¬Å“reasonable and customaryÃ¢â‚¬Â rate is only $77. The insurers then only reimburse 80%, covering $62 for a $200 bill, and leaving the patients to cover the $138 balance.
However, insurers argue that Mr. CuomoÃ¢â‚¬â„¢s investigation does not take into account how the doctors determine what they charge for their services.