Texas Medical Association Joins AMA in Lawsuit Against Aetna, Cigna
The Texas Medical Association on Tuesday said it joined the American Medical Association and several other state medical associations and physicians in two lawsuits alleging that Aetna and Cigna used a flawed reimbursement system that underpaid physicians and overcharged patients for more than a decade, the Dallas Morning News reports (Roberson, Dallas Morning News, 2/10).
The lawsuits were filed in New Jersey federal court on Monday. According to the lawsuits, the insurers used faulty data from UnitedHealth Group subsidiary Ingenix to determine physician payments. Investigations by New York state Attorney General Andrew Cuomo (D) found that the Ingenix database, used by many insurers to calculate reasonable and customary rates of reimbursement, had calculated rates between 10% and 28% too low. As a result, many people overpaid for out-of-network care. UnitedHealth, Aetna, HealthNet and MVP Health Care have settled investigations by Cuomo's office by agreeing to pay millions of dollars to patients and physicians affected by underpayments and to stop using Ingenix. The settlements also involve payments toward the development of a new, independent database to replace Ingenix (Kaiser Daily Health Policy Report, 2/10).
Josie Williams -- president of TMA, which represents the 44,000 physicians and medical students in Texas -- said, "It's time for Aetna and Cigna to stop this unethical business practice that shocks our patients with unexpectedly high bills for health care they thought they'd already paid for." Williams added, "It's time for them to stop cheating physicians and patients just to pad their own profits" (Dallas Morning News, 2/10).
Aetna spokesperson Cynthia Michener said the lawsuits are similar to lawsuits already filed by consumers in New Jersey and Connecticut state courts. She said, "We're disappointed the medical community has chosen to litigate on top of already pending consumer litigation on the same topic" (Murphy/Troise, AP/Philadelphia Inquirer, 2/11).
Cigna spokesperson Chris Curran said the suits are "without merit and will be vigorously defended" (Layton, Bergen Record, 2/10). Cigna in a statement said that its payments to out-of-network physicians are "robust and fair." For example, it said that New York City physicians charge on average $214 for a 15-minute out-of-network office visit and that health plans would reimburse as much as $160 using the Ingenix database for that visit, while Medicare would reimburse $77 (AP/Philadelphia Inquirer, 2/11).
