Aetna to pay $5 million to overcharged college students

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agreed this week to pay 73,000 students from more than 200 colleges $5 million plus interest and penalties for charging outdated rates to those who received care outside their network.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

For more on out-of-network health care, read "Make Sense of Your Hospital Bills," and "Medical Insurance Booby Traps," and learn how to negotiate your medical bills and check for errors.

Comments

[Toby Shea]

I have filed an compliant to the state regulator. I filed a claim to Aetna and it was approved in March. I called them every two weeks since and still have not gotten the check. For the past month, they told me the check is in the mail but I never received it. I don't know what is going on but I wish some regulator or advocate would look into this Chickering plan.

[Sarah]

$25?? More like $2500 for me! I mailed the paperwork promptly but have yet to receive payment. Maybe it'll take Aetna another 2.5 years to process it. Absolutely ridiculous!

[Tom Wilson]

Aetna Student Health Care is not a good option unless you have no insurance at all. They should never be selected as secondary coverage although they give off the impression you may need it. The reason is that Aetna is not able to determine consistantly within their own organization the issue of whether they are primary or secondary. We got medical copays reimbursed relatively easily (but not without hassles on whether existing conditions where waived - faxed documents several times before they finally got it) as secondary, but prescription drug coverage was never really handled properly. Their prescription drug people continued to insist they were primary and finally the problem was solved by the third manager I talked with going around their own system to reimburse prescription drug copays as some other form of treatment.

Funny thing was that as primary they would have been liable for several thousand dollars for the prescription drugs as primary versus $150 as secondary. At one time their customer service manager said prescription drug branch was going to reimburse prescription drugs as the primary insurer and when I said that meant they would pay me thousands, they said they understood that. I told him if they paid me several thousand dollars, I would consider that as payment for both the copayment and as compensation for the aggravation they created. Of course they never did pay as primary as they said they would.

[Angry student.]

Chickering was a piece of shit. I was one of the student and filed the claim with them. They can't even get the numbers right, of course, the "unintended" mistake results in their advantage. I just hate those greedy.