Aetna Inc. has agreed to pay as much as $120 million to settle litigation over its practices on the payment of claims for services by providers with which Aetna does not have a contract. The agreement calls for Aetna to pay $60 million, plus as much as $60 million more following a claims submission period that will begin after a court grants final approval to the settlement. The Plaintiffs alleged that Aetna improperly used third-party databases to systematically underpay claims involving services and supplies provided to members by out-of-network providers. The litigation also challenged other methods by which Aetna calculated out-of-network reimbursement rates, and its disclosures for how it calculated those rates.
Source: Claims Journal
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