Aetna Inc. will pay up to $120 million to resolve multiple class actions by subscribers, providers, and state medical associations claiming the insurer improperly used flawed third-party databases to systematically and uniformly underpay out-of-network providers, under a proposed settlement filed in a federal court in New Jersey Dec. 7. The proposed nationwide class action settlement filed in U.S. District Court for the District of New Jersey calls for Aetna to pay a guaranteed amount of $60 million into a general settlement fund and up to $60 million into a separate fund to be used to pay providers and subscribers who can document that the insurer underpaid specific claims for services and supplies. The accord would resolve a number of class actions dating as far back as 2007 that were consolidated in the District of New Jersey by the Judicial Panel on Multidistrict Litigation in 2009. The complaints challenged Aetna’s use of a database produced by Ingenix, a subsidiary of UnitedHealth Group Inc., to determine “usual and customary charges’’ for medical services rendered by out-of-network providers. The plaintiffs claimed Ingenix and Aetna intentionally manipulated data submitted to the Ingenix database to reduce reimbursements for out-of-network services, shortchanging providers and forcing patients […]
Aetna Inc. will pay up to $120 million to resolve multiple class actions by subscribers, providers, and state medical associations claiming the insurer improperly used flawed third-party databases to systematically and uniformly underpay out-of-network providers, under a proposed settlement filed in a federal court in New Jersey Dec. 7.
The proposed nationwide class action settlement filed in U.S. District Court for the District of New Jersey calls for Aetna to pay a guaranteed amount of $60 million into a general settlement fund and up to $60 million into a separate fund to be used to pay providers and subscribers who can document that the insurer underpaid specific claims for services and supplies.
The accord would resolve a number of class actions dating as far back as 2007 that were consolidated in the District of New Jersey by the Judicial Panel on Multidistrict Litigation in 2009.
The complaints challenged Aetna’s use of a database produced by Ingenix, a subsidiary of UnitedHealth Group Inc., to determine “usual and customary charges’’ for medical services rendered by out-of-network providers.
The plaintiffs claimed Ingenix and Aetna intentionally manipulated data submitted to the Ingenix database to reduce reimbursements for out-of-network services, shortchanging providers and forcing patients to pay an excessive portion of the cost of their medical care. The lawsuits also challenged other methods Aetna used to calculate out-of-network reimbursements and the insurer’s alleged failure to disclose those methods.
The agreement defines two proposed settlement classes. The provider class includes anyone who was an out-of-network provider or out-of-network provider group at any time since June 3, 2003, and whose services to Aetna plan members were paid at less than the billed amount. The subscriber settlement class comprises individuals who were Aetna plan members at any time since March 1, 2001, whose claims for reimbursement for services from an out-of-network provider were paid at less than the amount billed by the provider.
