Steps health care providers can take to claim funds from the $120 million settlement pool
Explore This IssueACEP Now: Vol 33 – No 02 – February 2014
Aetna has agreed to a settlement to pay claims that were reimbursed at less than usual and customary charges during a period from June 3, 2003, to Aug. 30, 2013, for out-of-network providers or provider groups. The settlement arises in part from Aetna’s use of the Ingenix database and Aetna’s out-of-network reimbursement policies that improperly reduced reimbursements for covered services. The WhatleyKallas law firm has prepared a step-by-step guide to claiming funds from the $120 million settlement pool.
Important note: For those providers or groups filing a claim, the claim form must be postmarked by March 28, 2014.
There are two options when filing a claim:
- Submit the required claim form without additional documentation, which would entitle you to receive $40 per year with a maximum of $410 for the entire settlement period (Simplified Claim Form).
- Submit the additional required documentation with your claim form to receive up to 5 percent of the allowed amount on each claim (Claim for Providers).
If you choose option 2, you release your right to balance-bill the patients involved in any of those claims. Also, you or your group should consider obtaining experienced health-care legal counsel advice, particularly if you or your group could have other claims against Aetna; by not opting out of the settlement class, you and/or your group could be releasing Aetna of any and all legal claims from June 3, 2003 through Aug. 30, 2013.
Read the complete guide from Whatley Kallas at www.acep.org/reimbursement. It includes detailed instructions and advice on which option is best for your situation. Act soon to be sure you don’t miss the filing deadline.
No Responses to “Aetna Agrees to Settlement Regarding Unfair Payments to Out-of-Network Providers”