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Understanding Out-of-Network Costs

New Yorkers who are confused or unaware of out-of-network health care costs now have somewhere to go for help: FAIR Health.
See Also: AARP on Medicare and Insurance

If you have private health insurance, you know how hard it can be to understand the bills and plan documents your insurer sends to you. And if you need to go outside your plan’s network for care, it gets even more complicated. How do you know how much you will owe? What’s an estimated price for the service you may need?
FAIR Health is an important new on-line resource made available to assist New Yorkers with understanding the out-of-network reimbursement system and estimating the costs they may be responsible for paying if they use out-of-network care.

The majority of Americans with private health insurance have plans that reimburse for out-of-network care. Under the terms of many of these plans, consumers are reimbursed based on insurer-determined “usual and customary” rates for medical services. Unfortunately, consumers typically are unaware of what these rates mean or how they are used to help determine reimbursement.
FAIR Health was established in 2009 in response to then-New York State Attorney General Andrew Cuomo's investigation into one of the insurance industry’s methods for determining reimbursement rates for patients who seek care from out-of-network providers. The investigation determined that such reimbursement policies were conflict-laden, potentially flawed, and unclear to patients seeking cost information. FAIR Health, Inc. was created with the mission to help ensure fairness and transparency in out-of-network reimbursement.
For more information and to view their on-line resources, visit FAIR Health.

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