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Life Health > Health Insurance > Health Insurance

Aetna settles federal out-of-network billing case

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HARTFORD, Conn. (AP) — Aetna Inc. (NYSE:AET) could pay up to $120 million under a proposed settlement of federal, class-action litigation over reimbursement for claims outside the insurer’s network of health care providers.

The Hartford, Conn., insurer said Friday that it will pay $60 million, most of it after the settlement receives final court approval, and then as much as $60 million more after claims are submitted and validated. Aetna, the nation’s third-largest health insurer, said it admitted no wrongdoing in agreeing to the settlement.

Aetna plans to take a $78 million, after-tax charge in the fourth quarter because of the settlement, which it expects to be approved by the middle of next year.

The case, In re: Aetna UCR Litigation, MDL No. 2020, which was filed in federal court in New Jersey, involves health plan members and providers suing over Aetna’s out-of-network reimbursement.

The first suit included in the litigation was filed in 2007, according to a report Aetna filed with the U.S. Securities and Exchange Commission (SEC)

The settlement class period for enrollees includes claims filed on and after March 1, 2001, up until the present.

The class period for providers includes claims filed on and after June 3, 2003, up until the present.

Aetna can get out of the settlement agreement if a large percentage of class members opt out of the proposed settlement, the company said.

The plaintiffs alleged that Aetna lowered data contributed to a database used to determine “usual and customary” (UCR) payment rates for care that patients got outside of their insurance network, and that helped lower Aetna’s payment obligations.

Several insurers have faced lawsuits over information they contributed to a database run by Ingenix, a subsidiary of UnitedHealth Group (NYSE:UNH). Aetna said its settlement involves claims calculated using that database and other methods.

Aetna, UnitedHealth and other insurers agreed a few years ago to help the New York attorney general’s office set up an independent public database to help calculate out-of-network expenses.

Aetna shares rose 83 cents to $44.26 in morning trading.

Allison Bell contributed information to this report.


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