NYS Medical Society Sues Aetna and CIGNA for Use of Ingenix Database to Determine Unfair Payments

WESTBURY, NY (02/10/2009)(readMedia)-- The Medical Society of the State of New York (MSSNY) joined the American Medical Association (AMA) and four other state medical societies yesterday afternoon in filing joint lawsuits against Aetna Health, Inc. and CIGNA Corporation for using UnitedHealth Group's Ingenix database for calculating out-of-network reimbursement payments to its insured members.

The suit alleges that the Ingenix system uses flawed data for determining usual, customary and reasonable (UCR) fees charged by out-of-network physicians in different geographical regions. Because the UCR fees calculated by Ingenix are lower than the actual UCR fees, the suit alleges that Aetna and CIGNA have not only failed to fairly pay their fair share of out-of-network physicians' fees but also cheated patients who have paid extra premiums for the ability to seek out-of-network care. Consequently, patients have often not been able to cover the extra out-of-pocket expense. MSSNY is, therefore, asking Aetna and CIGNA to abandon their use of the Ingenix database and to compensate physicians for lost revenue.

Michael H. Rosenberg, MD, President of the Medical Society of the State of New York said, "When patients pay an extra premium to be able to select a doctor of their choice, they are entitled to get what they paid for, especially in this time of economic crisis. Insurers should pay the percentage of UCR fee that their policies promised; so doctors, in turn, will be fairly paid. Patients should only have to concentrate on getting well, and doctors should be free to focus on providing them with the best care."