Suit Challenges Out-Of-Network Fee Calculations

A lawyer is trying to organize a class-action suit that would attack the methods a health insurer is using to estimate “usual, customary and reasonable” fees for out-of-network doctors and hospitals.

Barry Epstein, a Woodbridge, N.J., lawyer, has filed the suit, Cooper et al. vs. Aetna Inc., in the U.S. District Court in Newark, N.J.

Epstein alleges that Aetna Inc., Hartford, violated Employee Retirement Income Security Act by relying on a flawed database administered by a unit of UnitedHealth Group Inc., Minnetonka, Minn., to come up with unrealistically low estimates of usual, customary and reasonable fees for plan members’ care.