Finkelstein Thompson LLP is investigating allegations that large health insurers may have substantially underpaid "usual, customary and reasonable" (UCR) medical provider fees to insured consumers who arrange for out-of–network medical services. The underpayments can be costly to the insured consumer and to medical care providers.  

New York Attorney General Cuomo has been scrutinizing such underpayments for the past year. The Attorney General explained concerning recent investigation and settlement with several insurers that “Insurers . . . promise to reimburse [insured consumers and their providers] based on usual and customary rates … but then reimburse based on schedules compiled by one of their own [United Healthcare subsidiary Ingenix] . . . , which has an interest in depressing reimbursement rates. . . .They pretend an independent database underlies these rates — it does not. . . . ” The AG’s underlying concern is that insurers may pretend to be using objective data in determining usual and customary rates for out-of-network services, but in fact reimburse the insured consumer using data that is biased and not collected in a systematic way.  

View Attorney General Cuomo's Agreement with Aetna

Press Release: Attorney General Cuomo Reaches Agreement with Aetna

Press Release: Attorney General Cuomo Reaches Agreement with UnitedHealth Group Inc.

The American Medical Association has taken aggressive action against insurers’ underpayment  of UCR physician’s fees. AMA Complaint and AMA Press Release

If you are a customer of a health insurer or you are a medical care provider and are aware of situations where you believe inappropriately low UCR reimbursement was paid, or if you feel that you were harmed by an artificially low UCR reimbursement and wish to discuss your rights, please contact our Washington, D.C. office toll-free at (877) 337-1050 or by email at This email address is being protected from spam bots, you need Javascript enabled to view it .