Steps health care providers can take to claim funds from the $120 million settlement pool

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:

1. 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).
2. 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.