Settled cases may soon outnumber unresolved cases in the long litigation over health insurers’ use of an industry database that set “usual, customary, and reasonable” (UCR) rates for medical procedures. On Dec. 7, Aetna Inc. agreed to a $120 million settlement of claims that its reliance on the database led to low reimbursements for procedures performed by out-of-network providers. The Aetna agreement joins previous UCR settlements by UnitedHealth Group Incorporated and Health Net Inc. UCR suits are still pending against Cigna Corporation and WellPoint Inc.
But the potential resolution of the Aetna case doesn’t necessarily mean that the Cigna and WellPoint suits will be wrapped up soon, said D. Brian Hufford of Pomerantz Grossman Hufford Dahlstrom & Gross. His firm, which was first retained by the American Medical Association for UCR litigation in 2001, served as chair of the plaintiffs’ executive committee in the Aetna litigation. “This settlement doesn’t mean that those cases will settle, or for how much, because those cases involve other issues about how [Cigna and WellPoint] process claims,” Hufford said.
