A class action lawsuit against Aetna for systematically underpaying health insurance claims and sticking their insureds with the bill has settled for $120 million.

Aetna charged and collected higher premiums from its insureds to cover their treatment by out of network providers (ONET).  Aetna was supposed to pay the out of network providers at the usual, customary and regular (UCR) rates. The UCRs were supposed to be determined by using Ingenix, a program developed by United Healthcare, another big health insurance company.  But there were two glitches: (1) Aetna deleted some valid charges; and, (2) Ingenix removed some charges.  So the providers for some Aetna insureds were not fully paid, which meant the insureds were supposed to pay their providers for bills that were supposed to be covered by the health insurance that they bought from Aetna.

Source: American Association of Justice

 

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