Eligible Class Members

If certified, eligible Class Members are:

 Acute Care Hospital Provider Class – all acute care hospitals in the State of Alabama, not owned in whole or in part by any of the “Defendants”, that had a participation agreement with Blue Cross and Blue Shield of Alabama (“BCBS-AL”), that provided covered services, equipment or supplies to any patient who was insured by, or who was a member or beneficiary of any plan administered by a Defendant and that submitted a claim to BCBS-AL from July 1, 2009 to date (within four years prior to date of the filing of the action); or

Non-Acute Care Hospital Provider Class – all healthcare providers other than acute care hospitals in the State of Alabama, not employed by or owned in whole or in part by any Defendant, who had a participation agreement with BCBS-AL, who provided covered services, equipment or supplies (other than (1) those provided to members of or participants in Medicare, Medicaid or the Federal Employee Health Benefits Programs; (2) those covered by standalone dental or vision insurance; (3) prescription drugs; (4) durable medical equipment; (5) medical devices; or (6) supplies or services provided in an independent clinical laboratory) to any patient who was insured by, or who was a member or beneficiary of any plan administered by a Defendant, and who submitted a claim to BCBS-AL from July 1, 2009 to date (within four years prior to date of the filing of the action).

Case History

In 2007, several class action lawsuits were filed on the behalf of the Subscriber Class and the Provider Class accusing Aetna of providing insufficient reimbursement for ONET covered services by using the Ingenix databases and certain other policies to make reimbursement determinations. In December 2012, the class agreed to settle all claims against Aetna in exchange for a settlement involving payments by Aetna of up to $120 million. This settlement was terminated by Aetna in March 2014. At this time, the litigation is continuing. It is impossible to predict the outcome; however, it is possible that money may become available to eligible class members of one or both classes if a new settlement is reached with Aetna in the future.