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Aetna Agrees to Pay for Underpaid Claims

Published
  • December 10 2012, 12:10pm EST

Health insurer Aetna will pay up to $120 million to settle physician and consumer lawsuits charging that it underpaid for out-of-network services for years using a biased pricing database owned by another major insurer.

The American Medical Association and former New York Attorney General Andrew Cuomo, now governor of the state, sued multiple national and regional insurers during the past decade, charging them with using an intentionally inaccurate database from the former Ingenix software unit of UnitedHealth Group. The Ingenix unit is now part of UHG’s OptumInsight division. The suits alleged the database underpaid by up to 28 percent. Cuomo eventually got agreements from at least seven insurers to fund development of an independent database to determine out of network rates and to shut down the Ingenix database.

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