Aetna Nixes $120M Out-of-Network Provider Class Action Settlement

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On Friday, Aetna Inc. announced that it has nixed a proposed $120 million class action settlement over claims that the insurance company paid inadequate reimbursements for out-of-network providers by using faulty databases to determine the amounts paid, citing an excessive number of potential Class Members who opted out of the settlement.

“Based on a report provided to the parties by the settlement administrator, the conditions permitting Aetna to terminate the agreement are satisfied,” Aetna wrote in a report submitted to the U.S. Securities and Exchange Commission. “On March 13, 2014, the Company notified the New Jersey District Court and plaintiffs’ counsel that the Company was terminating the settlement agreement. Various legal and factual developments since the date of the settlement agreement led the Company to believe terminating the settlement agreement was in its best interests. Aetna intends to vigorously defend itself against the claims brought by the plaintiffs.”

According to documents filed with the court, the number of potential Class Members who opted out of the class action settlement exceeded the threshold indicated in the settlement agreement. The class action settlement website indicates that the Final Settlement Hearing that was scheduled for March 18 has been cancelled. However, the plaintiffs’ lawyers are currently investigating the reason for the termination of the class action settlement.

The Aetna out-of-pocket provider settlement was initially reached in December 2012. Under the terms of the class action settlement, Aetna agreed to pay up to $120 million to Class Members, who included health plan members and health care providers.

The Aetna out-of-pocket provider settlement would have resolved a group of class action lawsuits. The initial lawsuit was filed in New Jersey by Michele Cooper, an Aetna plan member. In 2009, a class action lawsuit was filed by a group of doctors and other health care providers. Both class action lawsuits challenged Aetna’s use of the Ingenix database and other methods to calculate out-of-network reimbursement rates. The class action lawsuits were eventually grouped into multidistrict litigation (MDL), known as In re: Aetna UCR Litigation.

For more information about the Aetna out-of-network provider settlement, keep checking www.TopClassActions.com or sign up for our free newsletter. You can also mark this article as a “Favorite” using your free Top Class Actions account to receive notifications when this article is updated.

The plaintiffs are represented by Carella Byrne Cecchi Olstein Brody & Agnello PC, Whatley Kallas LLP, Pomerantz LLP, Bonnett Fairbourn Friedman & Balint PC, Ridout Lyon + Ottoson LLP, Seeger Weiss LLP, Scott + Scott LLP, Kiesel Law LLP, Hoffman Libenson Saunders & Barba, and Zuckerman Spaeder LLP.

The Aetna Out-of-Pocket Provider Class Action Lawsuit is In re: Aetna UCR Litigation, Case No. 2:07-cv-03541, MDL No. 2020, in the U.S. District Court for the District of New Jersey.