Health Insurance Data
21 02 08 - 10:43
Re "A Rip-Off by Health Insurers?" (editorial, Feb. 18):
Ingenix compiles actual physician-billed charge data - more than 1.3 billion continuously updated records collected from 100 major contributors in 50 states - and licenses summaries of that information to health plans so they can use it to make better decisions. We believe that all markets, health care in particular, need more, not less, information so that quality and cost can be better understood and improved.
We do not know the source of the $77 figure your editorial cites from the New York attorney general as Ingenix's calculation of the "fair market rate in New York City and Nassau County for a 15-minute consultation with a doctor for an illness of low to moderate severity." Instead, a health plan reimbursing this consultation using our Prevailing Healthcare Charges System data at the 80th percentile would price this service at $160.
We stand behind the quality of this and other P.H.C.S. data. P.H.C.S. data serve as a valid, unbiased and useful basis for health plans to use in making their reimbursement decisions. Without this accurate market information, health plans cannot know with any confidence if the amount charged for a service is higher than, lower than or approximately consistent with what is generally charged for that service in that area.
There is absolutely no systematic bias that eliminates high charges in the data. We do not manipulate data so that our health plan clients can justify lower payment rates.
We believe that our data and methodologies are the best available to the industry. Moreover, we believe that the alternatives to the benchmark market data we offer are not in the best interest of the health care system. Health plans that offer out-of-network benefits would need to make reimbursement decisions based on government-set pricing similar to Medicare or in the absence of any statistical data at all.
We look forward to an open and balanced dialogue about the very real need to provide more accessible information to all stakeholders in the health care industry.
Andy Slavitt
Chief Executive, Ingenix
Eden Prairie, Minn., Feb. 19, 2008