To settle the issue, the insurance company relinquished the data, and FAIR Health, a nonprofit organization, was created to manage and update the data and provide it to consumers at no cost.
Explore This IssueACEP News: Vol 31 – No 07 – July 2012
Although the legal battle took place in New York, FAIR Health data covers transactions across the nation. A team of outside experts maintains and updates the information in the database so that it is current and analyzed properly. Emergency physicians are particularly interested in the FAIR Health data because their services are frequently reimbursed at the out-of-network level. That means that patients get less money from their insurance companies to cover the bill. When patients can’t or won’t pay the full amount, doctors often are forced to absorb the cost.
“It really affects emergency providers more than any other specialty,” Dr. Seaberg said.
ACEP would like to see the 80th percentile of FAIR Health added as an option for a measure of fair payment. The Medicare reimbursement rate bears virtually no relationship to real-world market conditions, doctors say. And patients are often surprised that reimbursement rates tied to Medicare do not cover more of their bills.
FAIR Health officials say they hear a lot of complaints from consumers and doctors. “It’s a very volatile, changing market out there,” said Ms. Gelburd of FAIR Health. Emergency physicians “should not be whipsawed by levels of reimbursement that don’t fairly reimburse them for their expertise.”
To watch a video of Dr. Michael J. Gerardi speaking about FAIR Health, go to www.acep.org/fairhealthvideo.