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Judge Approves Settlement in Emergency Provider Case Against Aetna
Settlement Agreement Will Impact Emergency Medicine Reimbursement
PINECREST, FL, May 5, 2009 - On April 15th, 2009, Judge Federico Moreno signed the Final Approval Order and
Judgment for settlement in the case of Weinberger, et. al. v Aetna Health, Inc., Case no. 1:06-cv-20249-Moreno/Torres.
The settlement addresses a class action lawsuit brought against Aetna Health, Inc for their interpretation of usual and
customary charges (U&C) as 125% of the Medicare fee schedule. Under the settlement, Aetna will pay non-contracted
emergency physicians at 239% of the Medicare fee schedule for services provided between June 3rd, 2003 and December 15th,
2008.
"This remarkable settlement should reset the bar in negotiations between emergency physicians and managed care payers.
Emergency physicians will feel less compelled to accept unduly low payment rates during negotiations with insurers," said
John Stimler, DO, CPC, CHC, FACEP, Managing Member, BSA Healthcare. "Settlement of this class action will have profound
effects regarding definition of U&C charges in states, such as Florida, that either have or are considering balance
billing prohibitions for emergency services," said Jeffrey Bettinger, MD, FACEP, Managing Member, BSA Healthcare.
To view the Final Approval Order and Judgment, click here. To learn more about how this settlement may affect emergency
physician reimbursement, please call Jeffrey Bettinger, MD, Managing Member of BSA Healthcare, at 305-860-3098 or email Dr.
Bettinger at jbettinger@bsanda.com.
BSA Healthcare is available to assist emergency physician organizations develop and implement effective strategies for dealing with managed care payers.
Our principals will advise ED groups on strategies to avoid participation in managed care agreements, or strategies to maximize payment rates when
non-participation is not an option.
About Bettinger, Stimler, Schultz & Associates
Bettinger, Stimler, Schultz & Associates (BSA Healthcare) is a physician-owned healthcare consulting firm that helps hospitals, academic medical centers,
private medical practices, and outpatient facilities improve quality, financial performance, operations, organizational structure, and strategic direction.
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