Who is Ingenix Inc.? Medical fees are determined and set by this company and accepted by some of the largest insurers. A six-month investigation has determined that Ingenix operates a defective and manipulated database that most major health insurance companies use to get reimbursement rates for out-of-network medical expenses. Are they defrauding consumers by manipulating reimbursement rates? How a patient is billed is being questioned by regulators across the country.
Ingenix was founded in 1996 to develop, acquire, and integrate some of the world’s best-in-class health care information technology capabilities. Ingenix is a wholly-owned subsidiary of United Health Group.
United Healthcare was ranked #21 on FORTUNE Magazine’s 2007 listing of the largest U.S. corporations and ranked #1 among the Most Admired Health Care Companies.
Rates set by Ingenix, Inc. are used by the five largest insurers in the nation and affect hundreds of thousands of patients from New York to California. With rising medical costs, record numbers of people losing their coverage, and healthcare at the top of the domestic agenda, health insurers find themselves in the cross-hairs of regulators, elected officials and law enforcement in California and across the nation.
Getting shortchanged? Ingenix data allow insurers to short patients on out-0f-network reimbursements.
example: 2007
Doctor's visit -15 min. rate for common illness.
Fair Market value -$200/ Igenix rate-$77/ Insurer rate (80%)-$62 / Consumer rate-$138.
The Insurer should pay $162 and Consumer should pay only $40
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