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Do your homework before going out of network

Two databases of usual, customary, and reasonable (UCR) rates owned by UnitedHealth Group’s wholly owned subsidiary Ingenix will soon cease to exist following two settlements in January between the insurer and New York State Attorney General Andrew Cuomo.

The databases have been used for years to determine payment for most out-of-network and other UCR services. But Cuomo’s investigation found that the databases understated the market rates of medical care by up to 28%, leading to systematic underpayments for out-of-network care.

At first blush, the dismantling of these widely criticized databases sounds like good news to providers who have declined to participate in increasingly draconian managed care contracts. However, some healthcare experts caution that the remedies provided by the settlement aren’t necessarily a panacea for the bigger issues plaguing out-of-network payments.