Wellpoint, which insures 35 million Americans, became the seventh health insurer to settle and agreed to pay $10 million towards establishing a new independent database operated by a non-profit organization that would allow consumers to learn how much their insurers will reimburse for common out-of-network medical services.
The new database will make rate information available to insurers.
Wellpoint also agreed to end its relationship with Ingenix, a Minnesota subsidiary of UnitedHealth Group that operates a database widely used by the health insurance industry.
Mr. Cuomo alleged that the health plans that have settled had conflicts of interest and used Ingenix’s allegedly flawed and defective database to manipulate reimbursement rates for out-of-network medical services at the expense of patients. The settlements have yielded $90 million towards funding the new database.
Mr. Cuomo alleged that Ingenix deliberately skewed the "reasonable and customary rates" low, compelling patients to pay more and insurers to pay less.
Wellpoint said it cooperated with Mr. Cuomo’s investigation. Wellpoint Executive Vice President Ken Goulet, CEO of the firm’s commercial business, acknowledged the conflict of interest in Ingenix’s database and said the company is committed to making healthcare costs more transparent.
Read Mr. Cuomo’s release about the Wellpoint settlement.
Read Wellpoint’s statement about the new out-of-network reimbursement database.
