Experts Present Specifics about FAIR Health and Other Alternatives Being Used Today by Employers and Health Plans to Set Out-Of-Network Rates

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Get the latest information on FAIR Health and other strategies for determining how to pay out-of-network providers in a January 10 webinar, sponsored by Atlantic Information Services.

Atlantic Information Services, Inc., publisher of Health Plan Week, Inside Health Insurance Exchanges, AIS's Health Reform Week and ACO Business News, is pleased to announce its January 10 webinar, Setting Out-of-Network UCR Rates: Evaluating FAIR Health’s Benchmark Data and New Alternatives for Insurers and Employers. See webinar details at

It’s been nearly four years since New York’s attorney general investigated the out-of-network reimbursement system used by insurers in the state and concluded it was flawed. UnitedHealth Group and 10 other insurers contributed nearly $100 million to a settlement, a portion of which was used to launch FAIR Health, Inc., a not-for-profit entity that has become a national clearinghouse for claims-based data.

Today, methods used to determine rates for out-of-network providers are coming under increased scrutiny. And rising deductibles and other out-of-pocket costs are leaving enrollees looking for tools that can help them estimate costs. Some medical societies have proposed that FAIR Health (and its 12 billion billed procedures for more than 120 million covered lives) become the default data source for determining rates for members who seek care from out-of-network providers. But some health insurers and self-insured employers have come up with alternative methods for determining Usual, Customary and Reasonable (UCR) rates for out-of-network providers.

Speakers Robin Gelburd, President of FAIR Health, Inc. and Robert Park a principal and consulting actuary in the New York office of Milliman will present the specifics about FAIR Health and other alternatives being used today by employers and health plans to set out-of-network rates.

During the 60-minute presentation and 30 minutes of Q&A, the speakers will answer these and other questions:

  • What models exist today for setting out-of-network rates? What are the chief advantages and disadvantages of each?
  • How does FAIR Health’s new database differ from Ingenix databases? What’s new? What remains the same?
  • What are the pros and cons of basing out-of-network rates on a percentage of Medicare? How will FAIR Health’s Medicare comparison tool work?
  • How will detailed consumer pricing information about out-of-network costs encourage members to stay in network?
  • What are the chances that FAIR Health will become the industry standard? What must take place for this to happen?
  • How should benchmarking data be used to determine charges under value-based payment mechanisms such as an ACO?

Visit for more details and registration information.

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Shelly Beaird-Francois
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