March 28, 2014, is the deadline for physicians to postmark claims for part of the $120 million settlement in a lawsuit against Aetna over payments for out-of-network services.
The settlement covers physicians and health care providers who delivered out-of-network services to Aetna subscribers any time between June 3, 2003, and Aug. 30, 2013, and received less than the billed charge.
There are two options for filing a claim. One involves submitting detailed documentation of the out-of-network services you provided, the bills you submitted to Aetna and the patients, and the payment you received. WhatleyKallas, LLP, one of the private law firms involved in the case, has published a step-by-step guide to help physicians and other health care providers maximize their recovery from the settlement.
TMA, the American Medical Association, and the medical societies of California, Connecticut, Florida, Georgia, North Carolina, New Jersey, New York, Tennessee, and Washington sued Aetna in 2009 over its use of databases licensed from Ingenix, a UnitedHealth Group Inc. subsidiary. Ingenix underpaid physicians for out-of-network services, the lawsuit said. It also challenged other ways Aetna determined out-of-network payment rates and accused Aetna of failing to disclose how it figured those rates. A patient filed a similar suit in 2007.
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.
Additional information about the settlement, including claim forms, can be found on the Aetna UCR settlement website.
Action, Jan. 17, 2014