Aetna to pay $5M over underpaid out-of-network charges

Aetna has agreed to pay more than $5.1 million to settle a suit charging that it underpaid thousands of consumers for out-of-network medical costs. The suit stems from state Attorney General Andrew Cuomo's year-long investigation of such underpayments, which has already resulted in a $350 million settlement [1] with the AMA and a $50 million settlement [2] with the state of the New York by UnitedHealth Group and subsidiary Ingenix.

Cuomo's office had alleged that its Aetna Student Health subsidiary had underpaid more than 73,000 students on out-of-network costs. The students will now receive reimbursement for their excess expenses.

In making these payments, Aetna had relied on the Ingenix database of physician charges, which UnitedHealth has agreed to replace with a database managed by a non-profit organization. The heath plan has already agreed to pay $20 million to establish the non-profit, and fund its efforts to collect new physician charge data.

To learn more about this settlement:
- read this New York Daily News item [3]

Related Articles:
UnitedHealth inks $50M settlement with NY over Ingenix charges [2]
NY sues UnitedHealth over MD payments [4]
New York AG expands health plan investigation [5]
UnitedHealth's Ingenix faces mounting legal troubles [6]