The state of Connecticut, as part of a new consumer protection law, has designated FAIR Health Inc.’s database as the official benchmarking database for determining reimbursement for emergency services received out of network, according to a FAIR Health news release today.
Fair Health is a national independent nonprofit that advances systemwide healthcare cost transparency through consumer resources, data products and health services research support.
Connecticut Insurance Commissioner Katharine L. Wade announced last week that under a new law that took effect Friday, if an insured individual receives emergency care in the state from an out-of-network provider, that provider can bill the insurer directly for those services. The insurer’s reimbursement to the provider must be the greatest of either its in-network reimbursement rate for the service in question, Medicare’s rate, or the usual, customary and reasonable (UCR) rate, the release said. The insured individual is responsible only for paying the coinsurance, copayment, deductible or other out-of-pocket costs required if the service had been received in network.
The state’s statute says the UCR rate is defined as: “the eightieth percentile of all charges for the particular health care service performed by a health care provider in the same or similar specialty and provided in the same geographical area, as reported in a benchmarking database maintained by a nonprofit organization specified by the Insurance Commissioner. Such organization shall not be affiliated with any health carrier.”
FAIR Health is the only organization specified by the commissioner as qualifying as the official data source.