Two More Large Insurers Agree To Ditch Faulty Database

Chalk up two more names to the growing list of insurance companies who have agreed to stop using a flawed insurance-industry database to calculate how much patients pay for out-of-network care.

Capital District Physicians’ Health Plan and Excellus, which collectively cover more than two million people, will stop processing claims through the Ingenix, Inc. database. The data was used by many insurance companies to overcharge patients for treatment outside their health insurance plans while shorting physicians for out-of-network treatment they provide, officials alleged.

New York Attorney General Andrew Cuomo has spearheaded efforts to clean up the insurance industry practice.

Ingenix is a subsidiary of UnitedHealth Group, one of the nation’s largest insurance companies, a relationship which created a conflict of interest in calculating reimbursement rates. Ingenix had an interest in keeping reimbursement rates low so the insurance companies could underpay for out-of-network services, investigators said.

According to Cuomo’s office, about 880,000 people in upstate New York had out-of-network plans through Excellus, which covers nearly two million New Yorkers and is the largest not-for-profit insurer in the state. Capital District Physicians’ Health Plan provides coverage for about 400,000 people in New York, officials said.

The insurance companies will now contact the thousands of member physicians who may have been underpaid over the past six years as a result of the company using the Ingenix database and arrange for the doctors to be compensated. 

The moves by Capital District Physicians’ Health Plan and Excellus to stop using the Ingenix database follow a string of similar agreements between Cuomo and some of the nation’s largest insurers. So far, insurance companies including WellPoint, Inc., BlueCross/Blue Shield, UnitedHealth Group Inc., Aetna, and Cigna have entered into similar agreements to stop using Ingenix and pay to create a new database for calculating reimbursement rates.

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