Aetna Out-of-Network Provider Class Action Lawsuit Settlement

Aetna Inc. has agreed to settle a class action lawsuit that alleges the health insurer paid inadequate reimbursements for out-of-network medical providers by using faulty databases and other methods to determine the amounts paid. Certain Aetna subscribers and out-of-network health care providers may be eligible for compensation under the class action settlement.

Who’s Eligible

Class Members of the Aetna class action settlement include the following Aetna subscribers and out-of-network health care providers:

  • Under the terms of the Aetna class action settlement, a “subscriber” refers to anyone who, at any time from March 1, 2001 through Aug. 30, 2013, was an Aetna plan member who received a covered service or supply from an out-of-network health care provider and whose resulting claims for reimbursement included partially allowed claims.
  • A “provider” refers to any people or entities who, at any time from June 3, 2003 through Aug. 30, 2013, were out-of-network health care providers who provided covered services or supplies to Aetna plan members and whose resulting claims for reimbursement included partially allowed claims.

If you fit into either of these categories, you may be eligible for reimbursement under the Aetna out-of-network provider class action settlement.

Potential Award

A cash award based on a pro rata share of the $120 million class action settlement fund after all expenses have been paid.

Proof of Purchase

N/A

Claim Form Deadline

3/28/14

UPDATE: On 3/14/14, Aetna announced that it terminated the class action settlement because too many Class Members opted out.

Case Name

In re: Aetna UCR Litigation, MDL No. 2020, in the U.S. District Court for the District of New Jersey.

Case Summary

The Aetna out-of-network provider settlement will resolve multidistrict litigation (In re: Aetna UCR Litigation) that accuses Aetna of relying on Igenix databases to determine the amounts paid, resulting in out-of-network providers being systematically under-reimbursed.

Final Hearing

3/18/14

Settlement Website
Claims Administrator

Aetna UCR Litigation
c/o Berdon Claims Administration LLC
P.O. Box 15000
Jericho, NY 11853-0001

Phone: 800-600-3079
Fax: 516-393-0031
aetna@berdonclaimsllc.com

Class Counsel

James E. Cecchi
CARELLA BYRNE CECCHI OLSTEIN BRODY & AGNELLO

D. Brian Hufford
Robert J. Axelrod
POMERANTZ GROSSMAN HUFFORD DAHLSTROM & GROSS LLP

Joe R. Whatley Jr.
Stephen A. Weiss
SEEGER WEISS LLP

Edith M. Kallas
WHATLEY KALLAS LLP

Christopher M. Burke
Joseph P. Guglielmo
SCOTT + SCOTT LLP

Defense Counsel

Richard J. Doren
Geoffrey M. Sigler
GIBSON DUNN & CRUTCHER LLP

Sign up for our free newsletter to get updates on new class action lawsuits and settlements.



37 Comments

  • jeannette henry December 21, 2013

    we had to file bankruptcy over Aetna not paying my medical bills, now two years later humana does the same thing to us even though our policy made our deductible the same for in or out of net work, we are left with a 30,000 dollar hospital bill alone because of the clause of reasonable and considerate or balance bill depending on who you talk too. and we had the hospital and doctors pre certify the surgeries they said we were good to go. and to top it off everything in the state of Wyoming was out of network so what were we suppose to do.

    • Rachael February 20, 2014

      usually if there is NO In-Network provider and or Facility within a 30 to 100 mile radius (depending on the Plan/ Carrier) a Health care plan/ Carrier will reimburse the claims at the In-Network rate covering at the In-Network level….one carrier’s desclaimer states: ” If you do not have access to any _(name of carrier here)____ network providers within a 30-mile radius of your home, you
      will be covered under the in-network level of benefits under the Out-of-Area Plan when you access
      providers. _(name of carrier here)____ determines who will be placed in the Out-of-Area Plan. Reimbursement is based on billed charges.
      The ________Health Program has a Network Gap Exception provision for Covered Health
      Services. Under this provision, if there are no in-network providers in the required specialty within a
      30-mile radius from your home, contact _(name of carrier here)____ prior to receiving the service (if possible) to request an exception under this provision to allow in-network benefits for services provided by an out of network
      provider.”
      I hope this helps you so you. You will need to find out what your Health Plan and or Carrier(s) state in their plan by using your plan booklet and or calling member services on the abck of your card to have them look it up.

    • Pamela Silva February 25, 2014

      I don’t know if any of this will answer your questions. I worked the insurance industry for forty years. There isn’t much I don’t know. What they are doing today is not insurance. What they call Consumer or Retail healthcare is an attempt to put it on the same level as any other business. And that is a wrong as it gets. When you take the word “patient” out of the business, you are in trouble. When I worked, I too, worked for companies that reimbursed you at PPO level if you were a specified amount away from a network dr. The question regarding them relying on someone else’s database for what they use as a cap for provider’s charges, insurance companies have always done that. Those companies, like INgenix today, run surveys to see what is an average charge for a service. The average is then called the reasonable and customary. What was bad, however, to me is that they did not pay 100% of the average, but they or the employers they served would choose the 85 or the 75% percentile of the average. So, they always cut it. PPO’s,however, would agree to it in writing, back then it was still just a small cut. Not like today. HOWEVER, hospitals do not use R & C. They have some calculation they use based on their chargemaster amounts. I wish I knew more about that. Only drs use the R and the C. Also, one thing I complained to two of my own insurance companies is about asking for money BEFORE a service is performed. They are not suppose to charge until the insurance company pays. My insurance company said, well, they TRY to ENCOURAGE them to not do that. Oh, brother. As to the provider’s responsibility. Your’s did more than most. An out of network dr is not responsible for getting the company to pay, although they are better prepared to fight it. If you think they have packed their charges try to get an audit. Or a copy of your original bill, see if it matches what you are receiving now. A lot of times it is so confusing and every customer service person give you a different story. Some of the rude things they have said to me I would have been fired for. I hope this helps anybody with anything.

  • pro-revolution December 28, 2013

    It’s a pretty sad day when we can’t even trust our own health insurers.

  • dana December 29, 2013

    why is this claim filing so difficult to fill and figure out, who ever came up with this know what they were doing, that’s not helping the regular people at all, anything to try and keep all that money.

  • 0kambb December 29, 2013

    Yes, I am with you dana. I receive the settlement letter from mail, and I do not understand how to fill it out either.

    • cynthia January 7, 2014

      Yes, I totally agree.I receive these paper in the mail
      Now what’s next?

  • Dolly December 30, 2013

    How are we suppose to find records way back to 2001? Aetna has info on us but it was so long ago I don’t have a member i.d. number to refer to to ask them for the info anymore. This should start another class action suit for the limited info available to file a claim after so many years. The insurance co. knows the info and knows they owe us money but won’t divulge this info unless we can provide our member ID from years ago. Scam artists!

    • JR April 4, 2014

      You don’t need to provide a subscriber number, the form clearly states you can use your ssn. The letter I received had a number above my name address this was most likely my subscriber number. I opted to use my ssn.

  • Kristie January 3, 2014

    I recieved a notice because obviously I was a customr of Aetna. I am not able to find a member ID number and would like to participate in the Class Action Suit. Any suggestions on ohow to get information from 2001 on?

    • singlemom January 12, 2014

      Write to aetns usng their claims information request authorization form as a subscrber they will send you the information back. Use your s s # they can pull i.formation for you let them do the work they have all of your records .

      • Jay B. March 4, 2014

        Where specifically can I locate these forms?
        Thank You,

  • Sherrell January 3, 2014

    I agree, this site is very difficult to file a claim on and Aetna and its team knows that most previous insured (member) no longer has access to their member number.

    This is very frustrating and unfair.

    There should be a lawsuit against them for requiring that we have our previous ID number.

  • Maki January 4, 2014

    My mother’s Out-Of-Network Provider billed Aetna directly for $39,998.00 for Left Heart Artery/Ventrical Angio performed in 2012 for which Aetna has paid the Provider only $1050.00. By the time Provider contacted my mother about it, Aetna said it was already too late for her to dispute or make any complaint regarding the amount paid by Aetna. (Apparently Aetna Member only has a certain number of days in which to file complaint. Where does it say that?) Many telephone calls to the Provider’s Billing Dept. and Aetna followed. Provider kept insisting they also were in direct contact with Aetna to get them to reconsider theie decision. Aetna denies any disputes/complaints were made by Provider after the initial decision. My mother has not paid anything to Provider since the only “bill” she received from Provider before Jan. 2, 2014, was the “whole bill” which included the amounts Aetna had already paid Provider. This was early January, 2013. Since then, all we heard from Provider was “We are trying hard to get Aetna to pay the rest of the bill.” Then suddenly yesterday she received a letter from the Provider dated Dec. 9, 2013, postmarked Dec. 31, 2013, with two “balance bills” from Provider dated May of 2013 totalling around $50,000.00, telling my mother to send them immediately to Aetna for payment, saying any amount Aetna fails to pay will be her responsibility to pay Provider! Furthermore, we suspect erroneous or intentional over charging!

    To make the long story short, it seems my mother does not qualify to claim Option 2 since she has not paid Provider anything since she had not received corrected balance bills until yesterday. Should it not be Provider’s responsibility to send in Provider’s Claim Form since they have always billed Aetna and dealt with them diretly bypassing my mother? If Provider for whatever reason chooses NOT to file Provider’s Claim Form (maybe because all the paperwork is too time-consuming?), what rights do they lose/retain, if any? Can they still come after my mother for payment in stead since it might by a much simpler alternative?

    Is it possible for my mother to opt for not being part of this Class Action while Provider goes ahead and submit Provider’s Claim Form? The obvious reason for declining to be part of the class action is to retain the right to be able to sue Aetna in the future should any mishandling of bills by Aetna is investigated and proven to be Aetna’s negligence?

  • singlemom January 12, 2014

    Lets all write to 60 minturs our voice matters in numbers i would like all my monies back that i paid out in medical insurance to aetna we do not have to agree with this settlrment. As a single parent i had to keep insurance likee many parents that have childten every pay period monies came out we as subscribers should not allow 500.00 dollars get our attention make a stand on principle who will receive fair justice? Opt out if you have paid more than 500.00 dollars in medical insurace to aetna in the last 13 years .

    • Jay March 5, 2014

      I did, and the local news…

  • Rebekah February 5, 2014

    We received the paper work for this but my husband has somehow misplaced it. Does any one know of any way to print out or request another one?

  • Susie February 10, 2014

    My out of network Emergency bill in November 2013 was not covered. Because the time period is given as March 1, 2001 through Aug. 30, 2013 I cannot even signed up for this claim.
    Any idea how I can get my bill covered?

  • Becky S February 18, 2014

    This is great, I have been an Aetna member since 2004!

  • Samuel February 24, 2014

    I work for a medical provider and we have been encountering major problems with Aenta since about March of 2013. Inappropriately handling provider disputes and claim denials. In some cases, if they request records and we submit them, they consider that an appeal and not only an appeal but the final level of appeal. Rebekah look up, it says right there “Click Here To File A Claim”. There is paperwork for Providers and paperwork for the Subscribers.

    • PeggyK March 6, 2014

      Unfortunately, after attorney fees are taken out, you will only end up with about $10.00.

  • Cindy March 4, 2014

    I was covered by Aetna from @ 1998 forward. I still have all my records for the most recent 5+ years but not back to 2001. so I filled out the request for info form and sent it to the attorneys via certified mail in December.

    When I got no response by February, I contacted the attorneys and was told that they were unable to get the info to me (and, I presume, to others) at this time. Since the deadline for filing a claim is March 28, 2014, they advised that I file a claim, furnishing no info (which results in smaller payout) and then file an amended claim later when/if I receive the info from them.

    Unbelievable.

  • Jay B. March 4, 2014

    I just received the package of information 1 week ago. This document is nothing but $5 & $10 dollar words I don’t understand… Is this just part of the original scam……

  • dolores kesemere March 18, 2014

    What does it mean that Aetna terminated the class action settlement..

    • Keisha March 25, 2014

      That’s exactly what I would like to know. Is it over or what?

    • brian green April 16, 2014

      I received the claim form. unfortunetly, I could pruduce any paperwork so I had to choose the option of receiving 40$ a year.I’ve been a member since 2001.I’ve paid several thousand dollars of pre tax medical payments out of my paycheck from my previous employer whom issued aetna medical insurance to me.i was receiving medical bill then& i’m still receiving medical bill now. was this all of Aetna taking my money,or was my former employer&aetna in on this scam together.how would I be able to find out who was taking my money

  • Goodconsuma March 25, 2014

    Who opted out? This is a joke!

  • NyCraig March 27, 2014

    this is what they call an insurance crisis throughout the United States! and why Obama created Obamacare. Insurance companies can’t afford to pay the spiraling out-of-control bills or claims. we’re paying insurance premiums for nothing. and now Obama is trying to force us to pay premiums! It should be illegal for a company to take in money and not perform it’s sole purpose of being in business….to pay medical claims!!! I know first hand how this crisis works. my father was a Aetna member until he died 2 years ago from cancer and a stroke. which bankrupted him in the process because both Aetna and MVP healthcare would SIMPLY NOT PAY HIS FUCKING CLAIMS!!

  • Jay March 28, 2014

    What a bunch of Crap! Why would you opt out??Just another way not to pay out anyone!

  • Becky March 29, 2014

    Are you freaking kidding me?!!? I went through all my old claims and payments for this settlement. What a bunch of BS!

  • Gloria April 7, 2014

    There be something for the ones of us who didn’t opt out?????????

    • Gloria April 7, 2014

      There should be!!!

  • Concerned April 7, 2014

    What can we do?

  • Dawn April 10, 2014

    I have the forms in my to-do folder and like others above, it is just too complicated. They have our records and should make it less daunting.

  • katherine wqinters April 11, 2014

    please let me know if this. opt out stuff is true. no one sent me anything through the mail or email. been looking for this check.

  • clifford kirkbride April 12, 2014

    I too would like an explanation of what it meant when Aetna says it has “cancelled” the settlement because too many people opted out? How can Aetna decide that? Don’t the courts make that decision? I need more explanations and a recourse to challenge this. Anyone out there with information please comment.

  • mary April 14, 2014

    is this for real or what

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

Categorized in: ,