Aetna agreed this week to pay 73,000 students from more than 200 colleges $5 million plus interest and penalties for charging outdated rates to those who received care outside their network.
The New York Attorney General’s office alleges that Aetna Student Health underpaid student claims in excess of $5 million between 1998 and April 2008. The health plans were sponsored by colleges and administered by Aetna Student Health, also known as Chickering. In cases where doctors didn’t charge the students the full out-of-network rate, Aetna will reimburse the doctors for the overbilling.
Cynthia Michener, an Aetna spokeswoman, says the miscalculations were caused by Chickering’s use of old data tables, and that the average underpayment was about $25. “Chickering has corrected the issue going forward and is reprocessing past claims that were affected,” Michener said.
Aetna has agreed to update the claims-processing system for these policies within 30 days of receiving new rate schedules. “We are very pleased that Aetna has agreed to refund $5 million to students who were shortchanged on their health-insurance claims,” said Chuck Bell, Consumers Union’s program director. “This national settlement also establishes strong consumer protections to ensure that students will be fairly reimbursed when they use out-of-network providers in the future.”
Aetna says it will give all affected individuals details on how to get reimbursed. If you think you’ve been affected, you can contact an Aetna customer service representative at 866-805-7643.
Previously, Aetna and United Health, two of the largest insurance companies in the U.S., agreed to pay a combined $70 million to help establish an independent nonprofit database to determine rates for out-of-network care.
—Kevin McCarthy, associate editor