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Pete Mackey
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UnitedHealth Settlement – Another View

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The UnitedHealth settlement with the state of New York has been hailed as a boon for healthcare plan subscribers wanting to use doctors who are not part of their network. Perhaps it is not all that it is cracked up to be, says Robert Laszewski, a healthcare consultant and president of Health Policy and Strategy Consultants, Inc. He believes that the settlement misses the mark, citing a blog post he had written when the lawsuit first came to light last year:

In a February 2008 post I said, "In a few months, we will hear that Ingenix paid a big fine and agreed to fix something (that no one will understand) andCuomo will have another notch in his belt."

Well, today it was announced that Ingenix will pay $50 million to set up an independent not-for-profit to operate the customary and reasonable database. The industry gets to continue determining what customary and reasonable physician charges are through this non-profit and just exactly how they do it will continue to be done by systems gurus the way systems gurus do things–pretty much in a "black box."While an undetermined university will operate the system, the industry, who will finance it, will presumably have a great deal of input into it. The industry’s use of the database will be more defensible since one of its own is no longer arguably directly controlling the entity.

$50 million is peanuts compared to the out-of-network customary and reasonable savings any one of the big health plans achieves every year and this settlement makes the ability of state medical societies and trial lawyers to attack the system much harder.

What is obviously needed is transparency. Doctors should get a fair fee for their services and the consumer should be able to figure out what the true cost of choosing an out of network doctor will be. Achieving transparency would protect everyone’s interests. Do you agree with Mr. Laszewski? If so, what is the best fix?