WhatleyKallas and Pomerantz Law Announce $120 Million Settlement with Aetna, Inc. Related to Out-of-Network Reimbursements
NEW YORK, Dec. 7, 2012 /PRNewswire/ -- On December 6, 2012, WhatleyKallas, LLC and Pomerantz Law, along with other firms representing Plaintiffs reached an agreement to resolve the In re: Aetna UCR Litigation, MDL No. 2020, NO- 2107-CV-3541 pending in United States District Court for the District of New Jersey. Pursuant to the settlement agreement, Aetna will create three settlement funds, valuing up to $120 million in total, from which out-of-network providers and Aetna's insureds will be entitled to make claims for reimbursement.
The Settlement arises out of an action that alleges that Aetna used databases promulgated by Ingenix, Inc., a wholly-owned subsidiary of United Healthcare, which were used to set usual, customary and reasonable ("UCR") rates for out-of-network services. The Ingenix databases are alleged to be inherently flawed and unable to establish proper UCR rates. Aetna, United Healthcare and other insurers agreed to stop using the Ingenix database pursuant to settlements with the New York Attorney General announced in 2009.
The Provider Class case was filed by a group of doctors and other healthcare providers in 2009, and was litigated along with cases brought by various individual subscribers who had been adversely affected by Aetna's UCR payment practices. This latest Settlement is another major development in WhatleyKallas's ongoing fight against insurers' alleged wrongful practices relating to reimbursement for services provided to patients on an out-of-network basis. Physicians and medical societies have previously settled very similar claims against United Healthcare resulting in significant relief for out of network healthcare providers. Pomerantz, led by D. Brian Hufford, head of the firm's Insurance Practice Group, served as lead counsel in the United Healthcare case.
According to Edith Kallas, senior partner at the firm, "This Class Settlement reflects years of hard work on the part of the provider class representatives and our medical association clients (the American Medical Association, Medical Society of New Jersey, Medical Society of the State of New York, Connecticut State Medical Society, Texas Medical Association, the North Carolina Medical Society, the Tennessee Medical Association, Medical Association of Georgia, California Medical Association, Florida Medical Association and the Washington State Medical Association). The provider class representatives and associations worked tirelessly to help bring about a result for the Class that helps compensate providers and insured for injury resulting from the alleged wrongful practices relating to out-of-network reimbursement that were at the heart of this litigation. The medical associations will continue to pursue relief to address issues on a forward looking basis for physicians and their patients."
"We are excited about this latest success in forcing managed care companies to follow the law," says D. Brian Hufford.
Adds Robert J. Axelrod, also a senior partner at Pomerantz, "This settlement provides an opportunity for providers to obtain reimbursement for monies taken by Aetna in the guise of usual, customary and reasonable payments. It brings to a successful close years of litigation on behalf of providers, for whom Pomerantz and WhatleyKallas have long fought against the largest health insurers in the country, including Aetna."
For more information about WhatleyKallas, please visit www.whatleykallas.com.
For more information about Pomerantz, please visit www.pomerantzlaw.com.
SOURCE WhatleyKallas, LLC