Patients and Physicians Are Clear Winners in Settlement with UnitedHealth Group

• by Medical Society of the State of New York

WESTBURY, NY (01/13/2009)(readMedia)-- On behalf of the Medical Society of the State of New York (MSSNY), I would like to thank Attorney General Andrew Cuomo for negotiating an agreement with the United Health Group and its subsidiaries - to finally end the abusive use of the Ingenix database to set rates for out-of-network medical payments.

This is a major advance in the Medical Society's mission to make absolutely transparent the way that managed care insurance companies do business. No longer can UnitedHealth Group make payments to out-of-network physicians based on data generated by one of their subsidiary organizations and presented to the public as being accurate.

I think it is critical to recognize that the end beneficiaries of this agreement are first patients and then physicians. Patients will benefit because they are one step closer to having an honest accounting for how their health care dollars are being spent. When a patient chooses to pay an additional premium for out-of-network benefits, they are entitled to have that care paid for in a fair and open manner. Physicians will benefit because they are a step closer to a system of honest reimbursement and transparent dealings with UnitedHealth Group.

At a time of national economic crisis, there is no doubt but that the most efficient use of the consumer's health care dollar is a national priority. This settlement underscores the commitment of Attorney General Cuomo's and the Medical Society of the State of New York to that end.

This settlement is also important because it signals to the patient and the physician community that even a juggernaut corporation with an $81 billion revenue stream in 2008 must play fair with the lives of those 72 million individuals for whom they contract to provide health care coverage. And playing fair means assuring the patients that the physicians who care for them will be fairly paid for the services they provide.

Today's announcement by Attorney General Cuomo also marks the achievement of a major goal that the Medical Society of the State of New York and the American Medical Association have been working on since 2000.

We thank Attorney General Cuomo for again coming to the assistance of our patients and our physicians. The Medical Society of the State of New York is pleased to have played a role in the investigation by Attorney General Cuomo, and we are pleased that United has agreed to help replace the flawed system. I would be remiss if I did not also thank my predecessor as MSSNY President, Dr. Bob Goldberg, who was involved in the settlements with other insurance companies, which were announced last year.

The medical associations continue to have a pending suit against United on related issues, which also has been brought on behalf of consumers and providers. We look forward to that case being resolved in a manner that will recognize United's responsibility to make just compensation for its prior use of the Ingenix database.

Thank you, Attorney General Cuomo, for inviting us to share in the announcement of this momentous victory.