NOTE: This is only for non-contracted Aetna claims. If your group has a contract with Aetna, this settlement does not apply. Click here to access a claim form in PDF format.


Highlights of the Proposed Class Action Settlement

• Non-par Physicians providing Emergency Services and Care to Aetna HMO members
   

• Class Period includes claims from June 3, 2003 through December 15, 2008
   

• Aetna established a New Florida ER Fee Schedule based on 239% of the applicable Medicare allowed amount.
   

• Aetna's Settlement Payment will be the difference between the amount of Aetna's original payment and 239% of the applicable Medicare allowed amount.
   

• Members will agree to accept 239% of the applicable Medicare allowed amount as payment in full
   

• Members will be subject to a Covenant Not to Sue for claims prior to December 15, 2008 and possibly FUTURE claims
   

Dates of Service June 3, 2003 - June 2, 2007

Physicians who were members of the Aetna's 2003 Shane Settlement are bound by the Covenant Not to Sue barring claims arising on or before June 2, 2007.

For physicians that were not part of the Shane Settlement for dates between June 3, 2003 and June 2, 2007, Aetna established a supplemental claims re-submission procedure through the Weinberger Settlement. The physician must:

• Complete the Proof of Claim - DEADLINE May 4, 2009
   

• Submit Supporting Documentation relating to the claims
   

• CLAIMS RE-SUBMISSION IS REQUIRED
   

Dates of Service June 3, 2007 through December 15, 2008

All Non-par physicians including Shane Settlement Members may be members for claims from June 3, 2007 through December 15, 2008.

Aetna will conduct a reasonable, good faith effort to locate claims paid less than the "New Florida ER Fee Schedule" (239% of the applicable Medicare allowable) for dates of service June 3, 2007 through December 15, 2008.

• Complete the Proof of Claim - DEADLINE May 4, 2009
   

• CLAIMS RE-SUBMISSION IS NOT REQUIRED
   

Claims Payment
 

• The Settlement Payment will be the difference between the amount of Aetna's original payment and the New Florida ER Fee Schedule (239% of the applicable Medicare allowable).
   

Opting Out of the Settlement
 

• Submit a signed statement indicating that you elect to opt out of the Settlement Class post-marked by April 3, 2009.
   

• Non-par Physicians providing emergency services in the claim period are automatically a class member unless opting out of the settlement but will not get paid without submitting a Proof of Claim form & Supporting Documentation by the deadline May 4, 2009.