AMA Joins Suit Against Aetna, Cigna

February 24, 2009
Special Feature

Fresh from a successful $350 million settlement with UnitedHealth over out-of-network reimbursements to doctors and patients, the AMA has joined with several state medical societies in filing a similar suit against health insurers Aetna and Cigna.

Fresh from a successful $350 million settlement with UnitedHealth over out-of-network reimbursements to doctors and patients, the AMA has joined with several state medical societies in filing a similar suit against health insurers Aetna and Cigna. The suit claims that the two health insurance firms systematically underpaid doctors and patients for out-of-network medical services. UnitedHealth has already agreed to pay $350 million to settle a separate suit that was also brought by the AMA and state medical societies.

At the center of the lawsuit storm is the database operated by Ingenix, a subsidiary of UnitedHealth, which several insurers use to calculate “usual and customary” fees for out-of-network medical care. The lawsuit alleges that Aetna and Cigna hid serious flaws in the database and manipulated the reimbursements by deleting high-end fees. The result was lower payments for out-of-network services that left patients paying more than they should have for those services. The suit covers payments made by the two health insurers over more than a decade.

As a result of a settlement with New York State Attorney General Andrew Cuomo, Aetna has already agreed to stop using Ingenix and pay $20 million toward the development of a new database that will replace it, joining UnitedHealth, HealthNet, and MVP Health Care, who are also paying into the project. Despite those agreements and the UnitedHealth settlement, both Aetna and Cigna vow to vigorously defend themselves against the AMA suit.