Aetna to pay $120M over underpaid out-of-network claims

Aetna will pay as much as $120 million to settle allegations that it underpaid claims when members received services from out-of-network providers.

Consumers and providers accused Aetna in class-action lawsuits originating in 2007 of improperly using databases from Ingenix, a former unit of UnitedHealth, to systematically pay less than the claims were worth, Reuters reported.

Under the settlement, Aetna will allocate $60 million toward a general settlement fund and will pay up to another $60 million for any additional claims that are submitted and validated through the settlement date, which is expected mid-2013, reported the Philadelphia Business Journal.

Aetna, however, didn't admit any wrongdoing and said it can terminate the agreement if a certain number of class members opt out, reported the Dow Jones Newswires.

As a result of the allegations, UnitedHealth shut down Ingenix and paid $400 million to help establish a new database that sets out-of-network rates and provide restitution to customers.

To learn more:
- read the Reuters article
- see the Dow Jones Newswires article
- check out the Philadelphia Business Journal article


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