NY Settlement on Out-of-Network Charges & Government Price Fixing

Folks who follow that previous thread will note that I am not a fan of the way insurers calculated UCRs, but that’s not because I think there’s a conflict of interest in their doing so. Rather, it’s because I think the whole network model is absurd, and an artefact of the government artifically favoring group versus individual ownership of health insurance.

Nevertheless, as Mr. Cuomo noted in his presentation (at 17′47″ on the video), 70% of Americans have plans that allow them to go out of network. So, something must be working for this model to persist.

Mr. Cuomo has established his health-care pricing database monopolist at Syracuse University, which is thrilled to have control of $100 million to establish its new non-profit business, which it calls FAIRHealth. Within a year, Ingenix will be out of this business, and FAIRHealth will be providing UCRs to the health-care sector and the public. (The NY Insurance Department has drafted a regulation to support Mr. Cuomo’s intent.)

I’m sure that there are many unintended consequences to this significant step, which I have not yet figured out. But core fact is this: Every claim for medical services in New York (and, Mr. Cuomo hopes, the nation) will soon be monitored and controlled by a non-profit monopolist appointed by the Attorney-General of New York.

This blog post originally appeared on StateHouseCall.org.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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