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New Out-of-Network Physician Pay Dbase is FAIR

Health insurers will soon have a new, independent database to use for determining out-of-network payment rates for physicians. Not-for-profit company FAIR Health Inc. and an Upstate New York research network headquartered at Syracuse University are charged with the task of developing the new database.

The FAIR (Fair and Independent Research) database will be marketed and administered by FAIR Health; who, in turn, will be governed by a board of directors that will include a medical representative. The Upstate New York network of researchers will compile the data and create the product.

Together, FAIR Health and network researchers also will create and publish a public Web site that will allow physicians and patients to see a simplified version of the information insurers will be privy to, such as usual, customary and reasonable rates.

“FAIR Health and the upstate research network headquartered at Syracuse University will bring much-needed transparency, accountability and fairness to a broken consumer reimbursement system we have called Code Blue,” said N.Y. Attorney General Andrew Cuomo in an Oct. 27 press release.

Cuomo is referring to the UnitedHealth Group/Ingenix debacle. UnitedHealth agreed to shut down the Ingenix database Jan. 13 after the N.Y. attorney general’s office accused the companies of rate fixing. Neither company confessed to any wrong doing but they, along with several other insurers who used the Ingenix database, put up over $100 million to support the development of this new, independent database. 

Work on the FAIR database began Oct. 27 and should be operational by fall of 2010, according to American Medical News (Berry, Nov. 9).

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