Aetna to pay up to $120M over reimbursements

By Patrick Gallagher

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Aetna Inc. agreed to a settlement of up to $120 million with patients and out-of-network health care providers over accusations that the Hartford-based health insurer underpaid certain claims.

Under the terms of the settlement, which was filed Dec. 7 with the U.S. District Court in Newark, N.J., and is pending court approval, Aetna would pay $60 million into a general fund and up to $60 million more depending on the number of people who submit claims.

The plaintiffs claimed Aetna used databases provided by Ingenix Inc. to underpay claims involving care and other services delivered by out-of-network providers over a sustained period of time. The settlement would cover patients who used out-of-network providers from March 1, 2001, to the present. It would also cover out-of-network providers who provided care from June 3, 2003, to the present.

Aetna said it would take a $78 million after-tax charge in the fourth quarter as a result of the settlement, and that the settlement would not impact operating earnings.

The settlement, which stems from litigation originally filed in 2007, could be approved by July 2013, according to Aetna.


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Patrick Gallagher
Bio: Fairfield County Bureau Chief Staff Reporter Westchester County Business Journal Covers: Economy, energy, government, infrastructure and public works projects, law, media, technology Phone: (914) 694-3600, ext. 3017

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