AMA EFFORTS TO FIGHT INSURER SCHEME PRODUCE RESULTS FOR CURRENT AND FORMER MEDICAL STUDENTS

The American Medical Association (AMA) is alerting medical students and residents that they may be entitled to settlement money if they were covered by Aetna Student Health while at college between 1998 and 2008. Aetna Student Health, formally known as Chickering Student Health, is a health plan administered by Aetna and sponsored by colleges and universities.

 

Aetna recently announced an agreement with the New York attorney general requiring the insurer to pay $5 million plus interest and penalties to 73,000 students from more than 200 colleges across the U.S. who were shortchanged on reimbursements for out-of-network care.

 

The inadequate reimbursements stem from outdated information that Aetna Student Health used from the databases of Ingenix, a UnitedHealth Group unit. During the last nine years, the AMA has worked diligently with regulators and the courts to expose how the Ingenix database has corrupted the system used by health insurers for out-of-network reimbursements.

 

"Medical students were particularly vulnerable to this insurer scam because they simply can't afford to overpay for health care while pursuing an expensive medical education," said AMA President Nancy H. Nielsen, M.D. "We fought many years to expose the flawed data insurers were using to under-reimburse patients and physicians for out-of-network care, and those efforts are paying off."

 

Evidence gathered by the AMA was brought to the attention of New York Attorney General Andrew Cuomo.  The AMA's insight into the insurer scam led Attorney General Cuomo to investigate the abuses and forced Aetna to announce plans to reimburse students it underpaid.

 

Aetna's announcement comes on the heels of a historic January 13 settlement in which UnitedHealth agreed to pay up to $350 million in damages for using the flawed Ingenix database to determine out-of-network reimbursements. That agreement resolved a class-action lawsuit brought by the AMA and others.

 

"Our litigation is definitely having a ripple effect throughout the insurance industry," said Dr. Nielsen. "The AMA has sent a clear signal that it will no longer tolerate the improper business practices of health insurers who decide to play by their own rules without regard to patients or the legitimate costs required to care for them."

 

Under pressure from the AMA and others, several insurers including UnitedHealth and Aetna have agreed to underwrite the creation of a new independent database that will be used in determining out-of-network reimbursement rates in the future.

 

Current and former medical students who were covered by Aetna Student Health between 1998 and 2008 will have their claims for out-of-network reimbursement re-processed by Aetna. Those who were under-reimbursed will be notified by letter and paid directly by Aetna – it will not be necessary to file a claim.  Details of the Aetna agreement with the New York attorney general can be reviewed at: http://www.oag.state.ny.us/bureaus/health_care/HIT2/pdfs/Aetna%20Student%20Health%20AOD.pdf

 

If you think you have been affected, please contact an Aetna customer service representative at (866) 805-7643.