Frequently Asked Questions
- What is the Attorney General's investigation about?
In 2007 and 2008, the Attorney General received complaints from consumers about the rate of reimbursement they were receiving from their insurers for out-of-network care.
The reimbursement was supposed to be based on the usual and customary rates of doctors for those services. As a result, the Attorney General began an industry-wide investigation.
- What did the Attorney General find in his investigation?
The Attorney General found that the out-of-network reimbursement system is broken. The system must be reformed to remove conflicts of interest, generate fair rates and bring clear information to consumers. The Attorney Generals findings and principal recommendations for reform are described in the Health Care Report: The Consumer Reimbursement System Is Code Blue.
- How do I file a complaint about my out-of-network reimbursement?
If you are a New Yorker and you believe you have been under-reimbursed by your health insurer for out-of-network costs, please click here File a complaint
- How will the reforms affect me?
The Attorney General's reforms will remove conflicts of interest and lead to reimbursement rates that are more accurate and fair. The Attorney General's reforms will also lead to a new website available to consumers that will allow you to make more informed decisions about your health care costs. The website will for the first time enable you to look up in advance how much you are likely to be reimbursed if you choose an out-of-network doctor.
- Who will operate the new database?
FAIR Health, Inc., a not-for-profit organization that is independent from the health insurance industry operates the database. FAIR Health has partnered with a team of research universities that constitute the Upstate Health Research Network (UHRN), to develop and maintain the database of healthcare charges.
How do I access the new consumer website?
- What if I have a complaint about my health insurance that does not involve out-of-network reimbursements?
The Attorney General's Health Care Bureau is available to assist New Yorkers with a variety of issues involving their health insurance. If you need assistance with a problem involving your health insurance, please click here