Following up on a story reported a couple of days ago, UnitedHealth Group has agreed to pay $350 Million to settle a billing dispute related to out of network claims. In addition, UnitedHealth pledged $50 Million and Aetna $20 Million to create a new database to determine our of network claims payment. The previous database that was used was operated by Ingenix, a UnitedHealth subsidiary which was at the center of the dispute.
The Ingenix database, contained claims payment data that is contributed by health insurance companies. The data is then used to set “usual and customary” charges for certain procedures, when members receive care outside of their network.
The lawsuit alleged that health insurance companies lowered the payment data when adding to the database, which allowed them to lower payments for future claims. The patient would then be billed the difference.
An investigation by the New York Attorney General’s Office found that health insurers had underpaid by 10-28% as a result of the inaccurate data in the database.