WellPoint paying to settle reimbursement probe-WEB ONLY

Indianapolis-based WellPoint Inc. has agreed to pay $10 million to settle a New York probe into how the health insurer reimbursed customers for out-of-network services.

WellPoint also agreed to stop using the Ingenix database of reimbursement rates that New York Attorney General Andrew Cuomo has called “defective and manipulated.”

“WellPoint acknowledges the conflicts of interest in the Ingenix database, which the Attorney General’s investigation brought to light, and we support his office’s efforts to increase the transparency of health care costs,” Ken Goulet, the CEO of WellPoint’s commercial business, said in a statement.

The Ingenix database, operated by Minnesota-based UnitedHealth Group, included reimbursement rates from numerous health insurers. Insurers referred to the database to set its reimbursement rates when one of its customers visited an “out-of-network” doctor – a physician who had not agreed to give discounts to the insurer’s customers.

Cuomo will use fees paid by WellPoint and its peers to create and fund a not-for-profit database to replace Ingenix that will be accessible both to insurers and their customers. UnitedHealth said in January it would discontinue the database.

WellPoint is the fourth major company to settle with Cuomo. A $10 million settlement by Philadelphia-based Cigna Corp., the fifth-largest U.S. health insurer, was announced yesterday. UnitedHealth, the nation’s biggest health insurer, settled for $50 million in an agreement announced last month. Connecticut-based Aetna Inc., the third-largest, agreed to pay $20 million.

“WellPoint is committed to appropriately processing claims and fairly reimbursing health care providers for covered services under the terms of each member’s contract, while at the same time protecting our members and group customers against excessive charges by some non-participating providers,” Goulet added.