Late last year, Aetna Inc. announced a proposed class settlement of up to $120 million over its use of the flawed Ingenix database. The settlement covered physicians and health care professionals 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.
The U.S. District Court in New Jersey planned to consider final approval of the settlement at a March 18 hearing. Less than one week before the hearing, Aetna notified the court it was invoking a provision of the settlement that allowed it to terminate the agreement if settlement claims of health professionals and subscribers opting out exceed $20 million.
Aetna told the court, "Based on the list of opt-outs provided by the settlement administrator to Aetna and class counsel, the opt-out levels exceed the threshold." Aetna did not provide specific numbers.
Attorneys for the plaintiff physicians are determining whether Aetna has properly terminated the settlement. If that is the case, the class action lawsuits against Aetna will proceed to trial.
Physicians who've been practicing medicine since 2003 and delivered out of network care to Aetna subscribers may be able to join as class representatives. If you wish to join the amended lawsuit, please email TMA Vice President and General Counsel Rocky Wilcox, or call him at (800) 880-1300, ext. 1335.
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.
UnitedHealthcare entered into a $350 million class settlement in 2009 for out-of-network underpayments. Aetna, United, and other insurers agreed to stop using the Ingenix database as part of the settlement, which created FAIR Health to take over and improve the database and establish transparent, current, and reliable health care charge information.
For additional information about the settlement, visit the Aetna UCR settlement website.
Action, April 1, 2014