If you or your business were an out-of-network health care provider or insured by Aetna from June 3, 2003 through August 1, 2011, an antitrust class action lawsuit alleging price fixing may affect you.
There is no monetary settlement at this time.
Eligible Class Members
There are two classes in this action – a “Subscriber Class” and a “Provider Class”.
Provider Class
If certified, eligible Class Members are: a) all Out-Of-Network (“ONET”) Providers or Provider Groups (defined below) who, at any time between June 3, 2003 and August 1, 2011, provided covered services or supplies to any participant or beneficiary of any Defendant (listed below or “Aetna”) insured or administered health plan which used the Igenix Database to determine ONET benefits and whose resulting claims for reimbursement
included Partially Allowed Claims (“PAC”, as defined below) based in whole or in part on information obtained from the Igenix Database
Subscriber Class
All persons or entities residing in New York who or which paid premiums for out-of-network health insurance
coverage from Aetna and received reimbursement for ONET between April 29, 2004 and August 1, 2011 based in whole or in part on information obtained from the Igenix Database
No Filing Deadline at This Time
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Defendants
The Defendants include:
Aetna Health Inc. PA, Corp., Aetna Health Management, LLC, Aetna Life Insurance Company,Aetna Health and Life Insurance Company, Aetna Health, Inc., and Aetna Insurance Company of Connecticut.
Definitions
- Definition of Out-of-Network Provider or Provider Groups:
A PAC means any claim line for a covered service or supply that is not a denied claim for which the “Allowed Amount” (defined below) is less than the billed amount. PAC’s are the only claims eligible for reimbursement in this litigation.
- Definition of Partially Allowed Claim:
A PAC means any claim line for a covered service or supply that is not a denied claim for which the “Allowed Amount” (defined below) is less than the billed amount. PAC’s are the only claims eligible for reimbursement in this litigation.
- Definition of Allowed Amount:
“Allowed Amount” means the amount Aetna determined to be eligible for reimbursement for a plan member’s covered services or supplies billed by an ONET Provider or Provider Group, before the application of co-insurance, deductibles, and coordination of benefits for coverage under another plan.
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Case History
In 2007, several class action lawsuits were filed on the behalf of the Subscriber Class and the Provider Class accusing Aetna of providing insufficient reimbursement for ONET covered services by using the Ingenix databases and certain other policies to make reimbursement determinations. In December 2012, the class agreed to settle all claims against Aetna in exchange for a settlement involving payments by Aetna of up to $120 million. This settlement was terminated by Aetna in March 2014. At this time, the litigation is continuing. It is impossible to predict the outcome; however, it is possible that money may become available to eligible class members of one or both classes if a new settlement is reached with Aetna in the future.
This is not an official Court Notice. Information contained in this Summary is subject to change. Class Counsel or the Settlement Administrator may be contacted for additional settlement information. You also may visit the Court-approved website, once it is available. Please understand that you have the right to file on your own. The information on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation.