Aetna Deal Creates Physician Payment Funds

Aetna has agreed to pay physicians and patients $120 million because it used databases that deflated rates for out-of-network services.

The decisions stems from settlement of a 2009 lawsuit against Aetna by TMA, the American Medical Association, and state medical societies in California, Connecticut, Florida, Georgia, New Jersey, New York, North Carolina, Tennessee, and Washington. The suit alleged Aetna used databases created by Ingenix, Inc., a subsidiary of UnitedHealthcare, to set usual, customary, and reasonable (UCR) rates for out-of-network services. It said Ingenix databases were inherently flawed and unable to establish proper UCR rates.

Physicians will be notified once the judge in the case approves the settlement, and they will have 90 days to file a claim, said Edith Kallas, an attorney for the plaintiffs. The notice will include information about how to file a claim.

Aetna, United, and other insurers agreed to stop using the Ingenix database in settlements with the New York State Attorney General in 2009. That settlement created FAIR Health to take over and improve the database and establish transparent, current, and reliable health care charge information.   


Action, Dec. 17, 2012


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