new database helps patients anticipate costs

I'm a little late on this, but it's interesting: two weeks ago, NY Attorney General Andrew Cuomo announced the creation of a database of doctor's fees and insurance reimbursement rates, designed to help patients who want to see an out-of-network health care provider anticipate what it will cost.

The New York Times reports that insurers often reimburse only a percentage of the cost of an out-of-network provider. However, sometimes that cost is not what the provider has billed, but rather what the insurance company has determined is "reasonable and customary" based on the fees other providers in the same area charge for similar services. In the past, insurance companies have been accused of systematically lowballing the "reasonable and customary" number, leaving patients to make up the difference. The purpose of the database is both to help the insured estimate what they will be reimbursed before seeing the out of network specialist, and also to assess the fairness of their insurance company's "reasonable and customary" estimate.

The database is being funded by several insurance companies, in particular UnitedHealth Group, as part of a settlement with Mr. Cuomo reached last January when he brought suit against them for deflating their "reasonable and customary" estimates.