Florida Sides With Big Insurance, Not Patients, in Deal with the Health Care Cost Institute

PR Newswire

WASHINGTON, Jan. 27, 2016 /PRNewswire-USNewswire/ -- The Florida College of Emergency Physicians (FCEP) and its national organization, the American College of Emergency Physicians (ACEP) today protested the state's award of a contract to a company (The Health Care Cost Institute or HCCI) that is sponsored by four of the largest health insurance companies. HCCI was hired to create a website for consumers to locate and compare health care services by price.

ACEP and FCEP said the partnership of the Florida Agency for Health Care Administration with the Health Care Cost Institute (HCCI) goes against the goal of creating an independent and transparent web tool, and their financial relationship with insurers raises concerns about their objectivity and validity of their data.

"The HCCI data come from the health insurance industry, and there is no transparency or independence," said Jay Falk, MD, president of FCEP. "There were other contenders for the contract, including Fair Health, Inc., which has been recognized for its independence and transparency by Kiplinger's Personal Finance as the 'Best health care cost estimator' in 2016. We strongly urge Floridians to let their voices be heard about this contract that will benefit insurance companies, not consumers."

Dr. Falk said the Fair Health claims database (www.fairhealth.org) was developed after United Healthcare was successfully sued by the State of New York for fraudulently calculating and significantly underpaying doctors for out-of-network medical services (using the Ingenix database). The formula they used forced patients to overpay up to 30 percent for out-of-network doctors. The company paid a large lawsuit settlement to the state of New York and the American Medical Association over its use of Ingenix. Part of the settlement proceeds were used to create the Fair Health database, which is an independent, unbiased source of health care cost information.

"It's disturbing that the state of Florida would opt for this vendor that is principally owned by the insurance industry," said Rebecca Parker, MD, FACEP, president of ACEP. "Health insurance companies have a long history of denying claims and selling so-called 'affordable' policies that cover very little (until large deductibles are met) — and then blaming medical providers for charges. For years they denied emergency claims based on final diagnosis, instead of symptoms, until the 'prudent layperson' standard was enacted into law."

The prudent layperson protects patients by preventing insurance companies from denying claims when, for example, chest pain turned out to be a panic attack. This standard was included in the Affordable Care Act.

FCEP is the state chapter of the American College of Emergency Physicians, which is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.