Docs sue Aetna, Cigna over low payments for services

    A group of doctors associations are suing a pair of health-insurance companies for not paying New Jersey doctors enough for the care they provide to out-of-network patients. The American Medical Association joined doctors groups in New Jersey and four other states in accusing Aetna and Cigna of cheating the doctors and patients alike. WHYY’s Mary Fuchs reports from Trenton.

    A group of doctors associations are suing a pair of health-insurance companies for not paying New Jersey doctors enough for the care they provide to out-of-network patients. The American Medical Association joined doctors groups in New Jersey and four other states in accusing Aetna and Cigna of cheating the doctors and patients alike. WHYY’s Mary Fuchs reports from Trenton.

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    Aetna is accused of using company software to shortchange both doctors and patients when people go out of network for health coverage. Larry Downes, general counsel for the Medical Society of New Jersey, says it’s a big deal for the state since a lot of doctors here don’t participate in health plans.

    Downes: We do know that health insurance companies in New Jersey process millions of transactions annually and a certain portion of those transactions have resulted in underpayments to physicians and patients in New Jersey and this suit is going to seek to remedy that situation.

    Downes says the goal of this particular lawsuit is to pay back doctors and not patients. An Aetna spokesperson says if they are required to reimburse all out of network services, the end result will be higher premiums for everyone.

     

    Additional Information:

    The doctors groups and The American Medical Association accuse the companies of using a software program called Ingenix to underpay doctors and patients.

    Downes:
    That database is what’s used by many insurers to calculate those out of network rates. The data that’s gone in and the way its been analyzed and computed is in a faulty way. It actually works to underpay doctors for their services.

    Cynthia Michener is a spokesperson for Aetna Healthcare. She says the company can’t fully reimburse both doctors and patients who were not paid enough for out-of-network services.

    Michener: If everyone believes they are entitled to additional services, the health care system will bear the burden and increase costs for everyone.

    New York Attorney General Andrew Cuomo’s investigation into the Ingenix database found that it allowed health plans to underpay physicians in reimbursements on medical bills. New York’s medical society joined the lawsuit in New Jersey.

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