In his June 28 letter commenting on Attorney General Andrew Cuomo’s agreements with insurers to replace the flawed Ingenix database for determining out-of-network physician payments, Paul Macielak of New York Health Plan Association appears to have missed the point. The new database will provide transparent— and also objective and reliable—information on how much doctors actually charge for care of patients not covered by the plan(s) to which doctors belong.

Unlike the Ingenix database, the numbers will be gathered by an independent, non-profit organization that is not economically tied to insurers. These numbers will be mathematically averaged and analyzed by the same non-profit institution. And the resulting usual, customary and reasonable fees (UCR) that result from those computations will be readily accessible to patients and insurers and physicians alike online. All three will see the same numbers.

As a result, a physician will not be able to charge way above the UCR without the patient being able to find out, and the insurer will not be able to under-reimburse without the patient and the physician being able to find out.

David T. Hannan, M. D.

President, Medical Society of the State of New York