LAW
Aetna to pay up Company agrees to settlement over Ingenix BY CRYSTAL CONDE Even
after the death of the In- genix database, insurance companies continue to pay for its sins.
In December, Aetna be- came the latest insurer to agree to a proposed settle- ment to pay physicians and patients $120 million because it used Ingenix da- tabases that deflated pay- ments for out-of-network physician services. The decision stems from settlement of a 2009 law- suit against Aetna by the Texas Medical Association, the American Medical As- sociation, and state medi- cal societies in California, Connecticut, Florida, Geor- gia, New Jersey, New York, North Carolina, Tennessee, and Washington. They al- leged Aetna used databases created by Ingenix, Inc., a subsidiary of UnitedHealth- care, to set usual, custom- ary, and reasonable (UCR) rates for out-of-network services. They said Inge-
He praised TMA’s in- volvement in the lawsuit. “When TMA gets in- volved in a legal matter, other state societies take notice and frequently will join in. The association has done a superb job in lead- ing the charge on many of these legal disputes,” he said.
Anesthesiologist Frank Tonrey, MD, represented Texas physicians in the lawsuit against Aetna over Ingenix.
nix databases was flawed and unable to establish proper UCR rates.
Plano anesthesiologist Frank Tonrey, MD, was the class rep-
resentative for Texas physicians in the lawsuit against Aetna. He gave a deposition in the case and submitted records dated from 2003 to 2009 that showed Aetna didn’t properly pay all claims for out-of-network services he provided. “The settlement with Aetna is substantial, and I think Texas doctors should be pleased they’re able to recoup some of the money they’re owed,” Dr. Tonrey said.
Aetna, United, and other insurers agreed to stop using the embattled Ingenix database in settle- ments with then-New York State Attorney General An- drew Cuomo in 2009. That settlement created FAIR Health (www.fairhealth .org) to take over and im- prove the database and establish transparent, cur- rent, and reliable health care charge information. FAIR Health collaborates with a group of research universities known as the Upstate Health Research Network to maintain the database. It allows con- sumers and physicians to
calculate in advance, based on a patient’s insurance plan, how much they may receive for common out-of-network services in their area. In February 2008, the New York attorney general began looking into whether Ingenix intentionally skewed UCR charg- es downward through faulty data collection, poor pooling pro- cedures, and lack of audits. In announcing the settlement, Mr. Cuomo, now the New York governor, said he found that having a health insurer determine the UCR rate created an incentive for the insurer to lower the rates.
March 2013 TEXAS MEDICINE 29
BRETT BUCHANAN
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