Aetna to pay $120M over underpaid out-of-network claims
Aetna will pay as much as $120 million to settle allegations that it underpaid claims when members received services from out-of-network providers.
Consumers and providers accused Aetna in class-action lawsuits originating in 2007 of improperly using databases from Ingenix, a former unit of UnitedHealth, to systematically pay less than the claims were worth, Reuters reported.
Under the settlement, Aetna will allocate $60 million toward a general settlement fund and will pay up to another $60 million for any additional claims that are submitted and validated through the settlement date, which is expected mid-2013, reported the Philadelphia Business Journal.
Aetna, however, didn't admit any wrongdoing and said it can terminate the agreement if a certain number of class members opt out, reported the Dow Jones Newswires.
As a result of the allegations, UnitedHealth shut down Ingenix and paid $400 million to help establish a new database that sets out-of-network rates and provide restitution to customers.
To learn more:
- read the Reuters article
- see the Dow Jones Newswires article
- check out the Philadelphia Business Journal article
Aetna fined $1.5M for violating autism, contraception coverage
Aetna sues Michigan Blues for artificially raising market rates
Hospital group sues Aetna for allegedly denying out-of-network access
Blues plans sued for out-of-network fees
Group Health overcharged members for out-of-network services