CIGNA to Stop Using Ingenix Database
CIGNA announced recently that it has partnered with New York Attorney
General Andrew M. Cuomo to support the creation of an independent not-for-profit
organization to administer a new database to determine reasonable and
customary charges when people obtain covered care from doctors outside
of CIGNA’s network. CIGNA has agreed to contribute $10 million
to the new not-for-profit, which will help individuals get transparent
and accurate information about the costs of the care they receive. CIGNA
will also assist the new not-for-profit in this effort by providing
its relevant billing and claims data.
In keeping with the rest of the industry, many of CIGNA’s health
plans give individuals the option of choosing to receive care from a
physician who is in the company’s network or from a doctor that
doesn’t have a contract and isn’t in the network. The CIGNA
network provides access to doctors who provide high-quality care and
who have agreed to charge reasonable fees for their services. If an
individual decides to receive care from an out-of-network doctor, then
he or she is reimbursed based on a set fee, which previously was based
on the Ingenix database, and the individual is responsible for the difference
between the set fee and the billed charge.
A fully transparent system will provide consumers with additional information
to assist with their physician selection process. For instance, it will
reveal that for a 15-minute office visit in New York City—the
most common service—health plans on average allow $74 to in-network
doctors and as much as $160 using the Ingenix database to out-of-network
doctors. Medicare pays $70 to in-network doctors and $77 to out-of-network
doctors for the same office visit. However, on average, out-of-network
physicians (who charge in excess of the amount previously set by the
Ingenix database) charge consumers $214—for the same service.
More than 95% of office visits are made to in-network physicians today,
and CIGNA believes that increased transparency around physician pricing
will further support efforts to drive lower cost, high-quality care.
Source: CIGNA
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