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New York codifies out-of-network insurance rules

Wall Street Journal, June 19, 2009

New York Attorney General Andrew Cuomo said he has completed work in transforming health insurers' "conflict-of-interest-ridden system" for reimbursing patients who seek out-of-network medical care and announced a new state regulation codifying those changes. Insurer Health Net has agreed to stop using UnitedHealth's Ingenix database for used to calculate "reasonable and customary" fees for out-of-network payments. The company also agreed to contribute $1.6 million toward the creation of a new database. Cuomo called it the "final agreement" in the series of announcements about insurers agreeing to change the way they calculate payments for people who get healthcare from out-of-network providers.