Aetna Agrees to Pay for Underpaid Claims

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.

Now, Aetna will place $60 million into a general settlement fund to reimburse providers and members, and will contribute up to another $60 million as reimbursements warrant. The agreement covers patients who used out-of-network providers from March 1, 2001, to the present, and providers from June 3, 2003, to the present, Reuters reports.

Reimbursement, however, could take a while. UnitedHealth Group agreed to a $350 million settlement, but payments were not made until a federal judge in February 2012 released $200 million to settle claims that physicians filed. Under that order, another $50 million would go to patients and allied health professionals, and the rest to pay various fees.