If were an Aetna Subscriber who was an Aetna Plan Member who received certain Covered Services or Supplies from an Out-of-Network Health Care Provider or Out-of-Network Health Care Provider Group and your claim for reimbursement included Partially Allowed Claims, or if you were an Aetna Out-of-Network Health Care Provider or Out-of-Network Health Care Provider Group who provided such Covered Services or Supplies, You May Be Eligible To Receive a Cash Payment from the Aetna Out-of-Network Health Care Provider UCR Reimbursement Class Action Settlement.
Aetna, Inc. and various of its affiliates and subsidiaries (“Aetna” or “Defendants”) have reportedly agreed to a proposed settlement of a class action lawsuit against them in the United States District Court for the District of New Jersey (captioned as In re Aetna UCR Litigation, Master Docket No. 07-3541) alleging, among other things, that Aetna failed to provide sufficient health insurance reimbursements for certain Covered Out-of-Network Services or Supplies by using Ingenix Databases (i.e., the Prevailing Healthcare Charges System database and the MDR Payment System database) in determining reimbursement for Covered Out-of-Network health benefits, using Out-of-Network policies regarding reimbursement to improperly reduce amounts for reimbursement for Covered Out-of-Network health insurance benefits and failing to adequately disclose the use of the Ingenix Databases and the Out-of-Network policies of reimbursement in determining amounts to reimburse for Covered Out-of-Network health insurance benefits, purportedly in violation of various laws, including the Employee Retirement Income Security Act (“ERISA”), the Racketeer Influenced and Corrupt Organizations (“RICO”) Act, the Sherman Antitrust Act, according to the Aetna Health Insurance Out-of-Network Health Care Provider UCR Reimbursement class action settlement notice.
Who Is Included In The Aetna Health Insurance Out-of-Network Health Care Provider UCR Reimbursement Class Action Settlement?
The Aetna Health Insurance Out-of-Network Health Care Provider UCR Reimbursement settlement classes reportedly include, unless otherwise excluded, all persons who, at any time between March 1, 2001 and August 30, 2013, were Aetna Plan Members who received a Covered Service or Supply from an Out-of-Network Health Care Provider or Out-of-Network Health Care Provider Group and whose reimbursement claims included Partially Allowed Claims (i.e., Aetna Subscribers) and/or all persons who, at any time between June 3, 2003 and August 30, 2013, were Out-of-Network Health Care Providers or Out-of-Network Health Care Provider Groups who provided Covered Services or Supplies to Aetna Plan Members and whose reimbursement claims included Partially Allowed Claims (i.e, providers).
What Settlement Benefits Does The Aetna Health Insurance Class Action Settlement Provide?
The Aetna class action settlement will reportedly provide for the creation of a settlement fund of up to $120 million (up to $60 million for a general settlement fund, $40 million for a subscriber settlement fund and $20 million for a provider settlement fund). Aetna Out-of-Network Health Care Provider UCR Reimbursement settlement class members must file Claim Forms in order to be eligible to share in the Settlement Fund.
Where Can You Obtain More Information About The Aetna Class Action Settlement?
For more information about the Aetna Health Insurance settlement, contact the Aetna settlement administrator by writing to Aetna UCR Litigation c/o Berdon Claims Administration LLC, P.O. Box 15000, Jericho, New York 11853-0001, calling 800-600-3079, faxing 516-393-0031, emailing aetna@berdonclaimsllc.com or visiting the settlement website at aetnaucrsettlement.com
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