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'Prevailing Healthcare Charges System' Rate Schedule Challenged In New Managed Care Litigation
Health Plan Law 
[Guidance Overview] Aug. 7, 2009
Excerpt: Chaffin v. Humana (S.D. Tex.) challenges Humana's use of the 'Prevailing Healthcare Charges System' to establish rates of reimbursement for out of network providers. The case is brought by members of Humana's 'National Point of Service' insurance plan, according to the complaint. The complaint alleges that Ingenix, a subsidiary of United Healthcare Group, operates a proprietary database system known as the 'Prevailing Healthcare Charges System.' PHCS purportedly derives a percentile -segmented survey of 'usual and customary' charges by factoring in insurers' billing information for similar types of medical services.
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