TMA Sues CIGNA and Aetna to Stop Use of Secret Data That Shifts Medical Costs to Patients and Physicians

For Immediate Release 
Feb. 10, 2009

Contact: Pam Udall 
phone:(512) 370-1382 
cell: (512) 413-6807
Pam Udall 

Contact: Brent Annear 

phone: (512) 370-1381 
cell: (512) 656-7320
Brent Annear 


On behalf of its nearly 44,000 member physicians and medical students - and the millions of patients they treat - the Texas Medical Association announced today it has joined a pair of class-action lawsuits against CIGNA Corp. and Aetna Health, Inc.

The two lawsuits, filed late yesterday in New Jersey federal court, contend that for more than a decade the two health insurance companies used a flawed system to underpay physicians for out-of-network medical services and forced patients to pay an excessive portion of the costs.

"It's time for Aetna and CIGNA to stop this unethical business practice that shocks our patients with unexpectedly high bills for health care they thought they'd already paid for," said TMA President Josie R. Williams, MD. "It's time for them to stop cheating physicians and patients just to pad their own profits."

The complaints charge Aetna ( PDF ) and  CIGNA  ( PDF ) with relying on skewed data provided by UnitedHealth Group subsidiary Ingenix to set reimbursement rates for out-of-network care. Evidence from a recent investigation launched by the New York attorney general found that the Ingenix data is intentionally manipulated to allow health plans to scam physicians and patients by shortchanging reimbursements on medical bills.

In addition to the lawsuit, TMA is asking the 2009 Texas Legislature to take several steps that will help patients who so choose to use all the options in the health insurance they buy. TMA wants the legislature to give the Texas Department of Insurance (TDI) authority to hold health plans accountable for developing adequate networks. TMA also supports measures that grant TDI authority to require health plans to disclose internal methodologies or data sources they use to determine how much they pay for out-of network services. Last year, TMA also recommended to the Texas Sunset Commission that it suggest TDI have authority to look into data mining companies such as Ingenix.

"When health plans don't bother to put together a comprehensive network of physicians, they force patients to go out-of-network for the care they need," Dr. Williams said. "And when the insurance companies use their own secret formulas, they dump higher costs onto patients who thought they were exercising their options under their insurance policy to see the doctor of their choice."

The Litigation Center of the American Medical Association and State Medical Societies is supporting the lawsuits in partnership with the Connecticut State Medical Society, Medical Society of New Jersey, Medical Society of the State of New York, North Carolina Medical Society, and TMA.

TMA is the largest state medical society in the nation, representing nearly 44,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA's key objective since 1853 is to improve the health of all Texans.


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November 19, 2015

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