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FairHealth.org          CalPERS’ & Anthem’s Breach of PEMCHA & Knox Keene Act

Breach of Contract     Breach of Fiduciary Duties     Unfair Business Practices

Administrative Process, Tolling, Delayed Accrual


FairHealth.org is one of many data providers of comparable cost information. The following information is from http://www.fairhealth.org


About FairHealth.org


FAIR Health is a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health oversees the nation’s largest collection of healthcare claims data, which includes a repository of over 23 billion billed medical and dental procedures that reflect the claims experience of over 150 million privately insured individuals, and separate data representing the experience of more than 55 million individuals enrolled in Medicare. Certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts. FAIR Health licenses its privately billed data and data products—including benchmark modules, data visualizations, custom analytics, episodes of care analytics and market indices—to commercial insurers and self-insurers, employers, hospitals and healthcare systems, government agencies, researchers and others. FAIR Health has earned HITRUST CSF and Service Organization Controls (SOC 2) certifications by meeting the rigorous data security standards of those organizations. As a testament to FAIR Health’s data security and validation protocols, its data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers’ compensation and personal injury protection (PIP) programs. FAIR Health also serves as the sole official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website, available in English and Spanish and as an English/Spanish mobile app, that enables consumers to estimate and plan their healthcare expenditures and offers a rich educational platform on health insurance. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger’s Personal Finance. FAIR Health also was named a top resource for patients in Elisabeth Rosenthal’s new book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. For more information on FAIR Health, visit fairhealth.org.



Who is FAIR Health?


FAIR Health is a national, independent, nonprofit corporation whose mission is to bring transparency to healthcare costs and health insurance information through comprehensive data products, consumer resources and the support of health services research.

FAIR Health uses our database of billions of billed medical and dental services to:
•    Power an award-winning, free website (www.fairhealthconsumer.org) that enables consumers to estimate and plan their medical and dental expenditures. The website offers clear, unbiased educational articles and videos about the healthcare insurance reimbursement system, as well.  FAIR Health also offers our cost lookup tools and educational material about healthcare costs and insurance in Spanish at consumidor.fairhealth.org and as mobile versions through Apple’s iTunes store and, for Android devices, Google Play.
•    Create data products, custom analytics and interactive data dashboards that we license to businesses, government agencies, policy-makers, healthcare providers, researchers and others.  With our professional staff of experts in healthcare, statistics, technology and communications, FAIR Health strives to offer information to all stakeholders in the healthcare sector.

FAIR Health qualifies as a tax-exempt, public charity under section 501(c)(3) of the Internal Revenue Code.


Why was FAIR Health formed?


FAIR Health was founded in 2009 after then-New York State Attorney General Andrew Cuomo uncovered potential conflicts of interest in the methods that health insurers were using to determine reimbursements to patients who received care from providers outside their health plans’ networks. The Office of the Attorney General reached settlement agreements with health insurance companies that do business in New York State; those agreements focused on bringing fairness and transparency to the out-of-network reimbursement system.

FAIR Health was established as part of this settlement.  Our mandate was to create and maintain a new database of charge data for healthcare procedures, to offer consumers tools to make it easier for them to estimate out-of-network expenses and to make our data available for academic research.

While the investigation took place in New York, the settlement had national implications.  Since our inception, FAIR Health has established a national reputation for bringing cost transparency to the healthcare sector; FAIR Health data currently power a range of data tools that are used by healthcare stakeholders across the nation.


How was the FAIR Health claims database created?


In January 2009, then-New York Attorney General Andrew Cuomo announced the settlement of an investigation into the method used by certain health insurers to determine reimbursements for patients who receive care from out-of-network providers.  The settlement agreement reached with 12 health insurers focused on bringing fairness and transparency to the out-of-network reimbursement system by creating a non-industry, independent repository of claims data that would be overseen by a nonprofit organization.  FAIR Health was formed to establish that database and oversee the ongoing contribution of claims data to it. The FAIR Health database currently includes claims data from over 60 payors nationwide and covers 2002 to the present.
What is the purpose of FAIR Health and how is it unique?


FAIR Health is committed to promoting transparency in healthcare costs and health insurance information through comprehensive data products, custom analytics, interactive data visualizations and consumer resources.  As an independent, unbiased source of healthcare cost information, FAIR Health is the trusted data provider to a wide range of customers including but not limited to payors, healthcare professionals, government agencies, unions, consultants, pharmaceutical companies, employers, consumers and researchers.