Aetna Settlement Favorable to Psychologists and Their Patients

        Aetna Settlement Favorable to Psychologists and Their Patients

PR Newswire

WASHINGTON, Dec. 11, 2012

WASHINGTON, Dec. 11, 2012 /PRNewswire-USNewswire/ --The following is being
released by the American Psychological Association Practice Organization:

Aetna has agreed to a $120 million settlement of a class action lawsuit filed
by psychologists, other health care professionals and patients in the federal
court in New Jersey. The lawsuit alleges that Aetna used a faulty database to
underpay claims for services from out-of-network providers.

Aetna licensed the Ingenix database to determine payment for out-of-network
services. The Ingenix database, however, allegedly was flawed and consistently
understated what is known as the "usual, customary and reasonable" (UCR)
reimbursement rate. The UCR is supposed to represent the "going rate" that
health care professionals charge for their services in a particular geographic
area of the country.

These allegations were the basis for a class action lawsuit against Aetna
filed in 2009 by providers, policy holders and health professional
associations, including the New Jersey Psychological Association (NJPA). A
settlement was reached with Aetna on December 7^th.

Aetna, United HealthCare, owner of Ingenix, and other insurers agreed to stop
using the Ingenix database pursuant to settlements with the New York Attorney
General in 2009. That settlement led to the creation of the FAIR Health
database,designed to replace the Ingenix system with a more accurate and
transparent system. Insurers nationwide can use the FAIR Health database to
determine reimbursement rates for out-of-network claims. Like several
insurers, however, Aetna bases its rates instead on Medicare rates.

Barry Helfmann, PsyD, NJPA Director for Professional Affairs said, "We're
pleased with the outcome of this case and glad to see patients and their
psychologists getting compensation for past underpayments."

Additional class action suits against other companies that used the Ingenix
database are still pending. They include a case in which the California
Psychological Association is one of the plaintiffs against the
WellPoint/Anthem companies, and other cases in which NJPA is a plaintiff
against CIGNA and Horizon Blue Cross Blue Shield of New Jersey.

"We hope that cases like these will result in fairer reimbursement practices
by the insurance companies and ultimately create greater access to mental and
behavioral health services for patients," said Katherine C. Nordal, PhD,
executive director of the American Psychological Association Practice
Organization, which works with state psychological associations to provide
legal, policy, communications and other support on managed care lawsuits and
advocacy issues.

The American Psychological Association Practice Organization is an affiliate
of the American Psychological Association, the largest scientific and
professional organization representing psychology in the United States. APA's
membership includes more than 137,000 researchers, educators, clinicians,
consultants and students.

SOURCE American Psychological Association Practice Organization

Contact: Dr. Barry Helfmann can be contacted through the New Jersey
Psychological Association at 973-243-9800 or njpa@psychologynj.org; APA
Practice Organization: Luana Bossolo, +1-202-336-5899, lbossolo@apa.org.
 
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