Consumers in New York State and nationwide have a new ally to help predict how much they will have to pay for medical and dental care outside their insurers' approved providers.

They can now go to www.fairhealthconsumer.org to find out how much a dental service or procedure typically costs in their ZIP code, how much is typically covered by insurance plans, and how much they'll have to pay themselves -- all before they even go to the dentist.

As of Aug. 1, the same data will be available for all medical and surgical procedures.

The information is only an estimate, since exact fees and health plan details vary.

But it's designed to give consumers a reasonable idea of what the charges could be, based on common criteria. The numbers are based on a dizzying collection of data from insurers nationwide.

"We see that as an opportunity to put nutritional information on the insurance information that they're getting ... so they can actually see what the ingredients are to these reimbursement decisions," said Robin Gelburd, president of Fair Health, the nonprofit that created the website.

The free "cost-lookup" service, which resulted from a series of legal settlements by major health insurers to resolve an industrywide investigation in New York, is designed to shine some light on out-of-network costs and reimbursements, an area of health insurance that is little understood by consumers.

"The more people know, the more they can be engaged in this process. The more people understand what's going on, the better they're going to be [as] consumers," said Dr. Raul R. Vazquez, a doctor with the Urban Family Practice in Buffalo.

It's also intended to encourage competition among doctors and hospitals, since patients will now have a benchmark from which to compare their doctors' charges with those of others.

"It's great for patients to be able to see what the going rate in their area is," said Dr. Ronald J. Sadler of Inspire Dental Group in Amherst and Orchard Park. "It will ... enable patients to effectively research the cost of all procedures and allow them to make informed decisions when choosing providers."

Currently, patients who seek out-of-network medical care have no idea how much it costs or what they will pay until later, when they receive the "explanation of benefits" from their insurer. Even then, the information is notoriously hard to decipher.

In particular, out-of-network insurance payments are based on a fixed percentage of the "usual and customary rates" that doctors supposedly charge locally. In turn, though, those "usual and customary rates" are typically below what out-of-network doctors actually charge.

But the forms never explain how insurers arrive at those rates and percentages, often leaving consumers with hefty out-of-pocket bills.

"Our mission is to make sure there's transparency," Gelburd said. "We hope that we give rise to generations of consumers that feel more confident and equipped to understand the information they receive from their insurance company."

The data could also help those with high deductibles or no insurance. "That's great that they're putting it up," said Dr. Jeffrey J. Rice, CEO of Nashville, Tenn.-based healthcarebluebook.com, a 3-year-old online pricing guide of "fair" treatment prices. "Most consumers don't have good knowledge or understanding of how health care billing works and what they're expected to pay."

Sadler said the new service would help to rein in health insurers. "We truly believe it is pro-consumer and -provider and will add an important check and balance for the insurance industry," he said.

Insurers say they are collaborating with the nonprofit to iron out any technical or other wrinkles. "We've worked with them to make sure it gets implemented smoothly and works for plans as well as consumers," said Leslie S. Moran, spokeswoman for the New York Health Plan Association.

"Transparency is essential to meeting patients' health care needs," said Frank J. Sava, spokesman for Independent Health Association. "Having this same level of transparency concerning medical costs will now benefit all consumers."

The new nationwide service is the culmination of an investigation by the office of Andrew M. Cuomo, then New York's attorney general and now governor, into how health insurers set out-of-network reimbursement rates.

His fraud probe found rampant conflicts of interest, with the entire industry using a single database provider called Ingenix that assembled claims data from insurers across the country and used that to calculate "usual and customary rates."

The problem is that Ingenix itself was owned by United-

Health Group, the nation's No. 2 health insurer. Cuomo found that the rates Ingenix calculated were artificially low by as much as 28 percent, resulting in underpayments of hundreds of millions of dollars by insurers over 10 years while inflating what consumers paid.

Cuomo required the state's health insurers to pay tens of millions of dollars in fines and agree to stop using Ingenix. At the same time, he required UnitedHealth to divest the Ingenix database to a new nonprofit foundation, which would take over its work. And the insurer fines, totaling nearly $100 million, were used to finance the launch of the foundation.

Besides its headquarters in New York, Fair Health has an office at Syracuse University, which is the base for its collaborative research with other universities, including the University at Buffalo. In all, it employs 22.

"It was sort of deemed to be a crown jewel of this settlement agreement that this database would be created," Gelburd said. "While this was a New York investigation that gave rise to the settlement, it has national consequences."

jepstein@buffnews.comnull