Health insurers' customary charges to be revamped

Since the late '80s/early '90s, Clark has been receiving calls from people in dispute with their health insurers about "reasonable and customary" charges. This is a tactic used by insurers to shift costs away from themselves and onto consumers.

Say, for example, your doctor bills your insurer $100 for a procedure. Typically, the insurer might cover 80% and you would pay 20% after meeting a deductible. But using the guise of "reasonable and customary" charges, the insurer goes back to the doctor and says it's only reasonable for him or her to have charged $50 for the procedure. Suddenly, the insurer is only paying $40 (80% of $50) and you get stuck picking up the remaining $60 tab.

In a massive conflict of interest, insurers were actually using an internal database to calculate what level of reimbursement they would give out-of-network providers for reasonable and customary charges. A new settlement between UnitedHealth and the state of New York, however, will change all that.

Under the settlement, UnitedHealth will pay $50 million to build a more transparent database. In a predictable move, the company admitted no wrongdoing whatsoever.

If you're locked in an ongoing dispute with your insurer, Clark advises the following: Go to other doctors in your area and ask them what they would charge for the procedure in question. That will build a consensus to show that the charge should be closer to what your doctor says instead of what your insurer says -- and that gives you leverage to negotiate.