Texas Medical Association along with it’s own 44,000 members and other medical associations filed seperate lawsuits against Aetna and Cigna insurance company in a New Jersey federal court on last Monday.
They alleged the insurers for cheating the doctors as well as patients by using wrong payment system. The insurers actually depending on distorted data from a third party and blindly set their reimbursement rates when patients get care from doctors outside their networks.
Generally, insurers create “networks” of physicians, who sign contracts to accept discounted rates in exchange for the plans steering their members to them. Patients often are free to seek treatment from out-of-network doctors, but they have to pay a higher share of those physicians’ bills.
According to the physicians Cigna and Aetna set those rates by relying on a faulty database provided by a subsidiary of UnitedHealth Group named Ingenix. Their methods result in underpayments to doctors and leave patients on the hook for an excessively high portion of out-of-network medical bills.
However, Cigna issued a statement saying the medical associations’ lawsuit is without merit, and only a small percentage of its claims actually involve out-of-network physicians. Both insurers assured in a statements, that they would defend themselves vigorously. Source: Star-Telegram.com