NEW YORK, July 6, 2016 /PRNewswire-USNewswire/ -- FAIR Health, Inc., a leading national independent nonprofit organization that advances system-wide healthcare cost transparency through consumer resources, data products and health services research support, is pleased to report that as part of a new consumer protection law, the State of Connecticut has designated FAIR Health's database as the official benchmarking database for determining reimbursement for emergency services received out of network.
On June 29, 2016, Connecticut Insurance Commissioner Katharine L. Wade announced that under Connecticut's Benchmark Database Public Act 15-146, which became effective July 1, 2016, if an insured individual receives emergency care in the state from an out-of-network provider, that provider can bill the insurer directly for those services. The insurer's reimbursement to the provider must be the greatest of either its in-network reimbursement rate for the service in question, Medicare's rate, or the usual, customary and reasonable (UCR) rate. The insured individual is responsible only for paying the coinsurance, copayment, deductible or other out-of-pocket costs required if the service had been received in network.
As specified by the statute, the UCR rate is defined as: "the eightieth percentile of all charges for the particular health care service performed by a health care provider in the same or similar specialty and provided in the same geographical area, as reported in a benchmarking database maintained by a nonprofit organization specified by the Insurance Commissioner. Such organization shall not be affiliated with any health carrier." FAIR Health is the only organization specified by the Commissioner as qualifying as the official data source.
FAIR Health is known nationwide for its role in bringing transparency to healthcare costs and health insurance information through comprehensive data products, consumer resources and research tools, powered by the nation's largest collection of private medical and dental claims data. Currently, the database contains more than 20 billion medical and dental claims from 2002 to the present, and receives an additional 1.7 billion claims yearly.
Many state governments and agencies are adopting FAIR Health data as a standard for a variety of uses. New York has already designated FAIR Health's 80th percentile benchmark as a guideline for disclosing plan rules on reimbursements and as a factor for consideration in independent dispute resolution involving "surprise" out-of-network bills and emergency services. In California, FAIR Health benchmarks also serve as the statutory standard for a ceiling on provider charges for emergency care for low-income individuals. A number of states have utilized FAIR Health data in updating and revising their workers' compensation fee schedules. Policymakers in several other states are considering using FAIR Health data as a reference point in other consumer-oriented legislation now under consideration by various legislative bodies. In addition, federal and state officials have used FAIR Health data to support health systems research and to evaluate the intended and unintended consequences of healthcare-related statutes and regulations.
FAIR Health President Robin Gelburd stated, "It is gratifying that Connecticut has officially identified FAIR Health's data as a standard for out-of-network reimbursement under this important consumer protection law. This designation demonstrates again the esteem with which stakeholders nationwide regard FAIR Health's data as a fair, reliable and useful representation of marketplace healthcare costs."
About FAIR Health
FAIR Health is a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health uses its database of billions of privately billed medical and dental claims to power an award-winning free consumer website and to create data products serving all healthcare stakeholders, including government officials, researchers, consumers, providers, insurers and other businesses. FAIR Health has been certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, eligible to receive all Medicare claims data for use in nationwide transparency efforts. In addition, FAIR Health's data have been designated as the official data source for a variety of state health programs. For more information, visit www.fairhealth.org.
Executive Director Communications and PR
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SOURCE FAIR Health