Aetna pays up


A proposed $120M settlement with Aetna is near done. This is an old class action case which AMA, ten state medical societies and other plaintiffs filed against Aetna for low balling UCR fees using their Ingenix database. The database was developed and owned by United Healthcare and shared by the insurance industry to enable them to pay low fees for out of network services. The accusation was that Aetna purposely paid low fees for out of network services from 2003 to the present and therefore shifted the onus to collect from their patients instead of fair payment from the insurer. 
Similar suits against Cigna and Wellpoint will probably also lead to a settlement. How do you get some of the settlement? The largest amount fund is the general settlement fund of $60M. Clinicians need to demonstrate that they were out-of-network providers for Aetna during any of the years from 2003 to the present. It is estimated that you may receive an average of $40 for each of those years. Cost of the settlement, attorney fees etc will take a big chunk of the money. To collect more, clinicians may be able to get from an additional $20 million provider "prove-up" fund. You must submit documentation that you billed Aetna for out-of-network claims and balance-billed the patient but the patient failed to pay. There is also a $40 million prove-up fund for Aetna beneficiaries