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Monday, December 10, 2012

AETNA DEAL CREATES PHYSICIAN PAYMENT FUNDS

Aetna has agreed to pay physicians and patients nationwide up to $120 million because it used databases that deflated rates for out-of-network services. The agreement stems from settlement of a 2009 lawsuit against Aetna by TMA, the American Medical Association, and nine other state medical societies. The suit alleged Aetna used databases created by Ingenix, Inc., a subsidiary of United Healthcare, to set usual, customary, and reasonable (UCR) rates for out-of-network services. It said Ingenix databases were inherently flawed and unable to establish proper UCR rates. Physicians will be notified once the judge in the case approves the settlement and will have 90 days to file a claim.

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