Aetna $4.8 Million ERISA Therapy Settlement

Participants or beneficiaries of a health benefit plan administered by Aetna and governed by the Employee Retirement Income Security Act who received chiropractic or physical therapy services after July 12, 2012, may qualify to claim a cash payment from a class action settlement.

Aetna Inc. and Aetna Life Insurance Co. agreed to pay $4.8 million to settle a class action lawsuit alleging they, along with OptumHealth Care Solutions LLC, improperly charged administrative fees for certain chiropractic and physical therapy services.

Who is eligible for an Aetna payout?

Class members must meet the following criteria:

• They were a participant or beneficiary of a health benefit plan administered by Aetna and subject to ERISA.
• They received chiropractic or physical therapy services from a provider contracted with Aetna through Optum’s provider network after July 12, 2012.
• They or their plan were charged a coinsurance or plan responsibility amount based on a rate between Optum and Aetna that exceeded the provider’s contracted rate with Optum for the treatment provided.

There are two distinct classes in this settlement:

• Member class: All participants or beneficiaries of Aetna plans for whom coinsurance responsibility for a claim was assessed using an agreed rate between Optum and Aetna that exceeded the provider’s contracted rate with Optum for the treatment provided.
• Plan class: All participants or beneficiaries of self-insured Aetna plans for which plan responsibility for a claim was assessed using an agreed rate between Optum and Aetna that exceeded the provider’s contracted rate with Optum for the treatment provided.

How much is the ERISA payment?

The total settlement fund is $4.8 million, divided equally between the member class and plan class, with $2.4 million allocated to each group.

• For the member class, the amount claimants may receive is calculated as the total excess amount they paid for covered Optum provider services during the class period. This excess is defined as the difference between the rate agreed upon by Optum and Aetna and the provider’s contracted rate with Optum. If the total valid claims for the member class are less than $2.4 million, each eligible member will receive 100% of their calculated claim. If the total exceeds $2.4 million, payments will be reduced proportionally.
• For the plan class, payments are made to the Aetna plans themselves based on the total Optum fees paid above the contracted rate for Optum provider services. No payment will be made to a plan if the calculated payment is less than $500.

No claim form required

For most class members, no action is required to receive compensation for services between July 12, 2012, and Dec. 31, 2017. The settlement administrator will use Aetna’s records to calculate these claims.

However, those who have claims for services received after Dec. 31, 2017, must submit documentation showing their plan document (such as the summary plan description) did not disclose that the allowed amount could include an administrative fee. Documentation must be submitted by July 10, 2025.

Class members can submit documentation by mail or email:

• Settlement administrator’s mailing address: Aetna Optum Admin Fee Settlement Administrator, c/o Atticus Administration PO Box 64053 St. Paul, MN 55164
• Settlement administrator's email address: AetnaOptumAdminFeeSettlement@AtticusAdmin.com

$4.8 million Aetna settlement fund breakdown

The $4,800,000 settlement includes:

• Payments to member class: $2.4 million
• Payments to plan class: $2.4 million

Aetna will pay the following settlement costs outside the settlement amount:

• Settlement administration costs: $52,400
• Attorneys’ fees and costs: $3,550,000
• Service award to class representative: $20,000

Important dates

• Claim deadline: July 10, 2025
• Exclusion deadline: July 10, 2025
• Final fairness hearing: Aug. 22, 2025

When is the therapy fee settlement payout date?

Payments will be made after the court grants final approval of the settlement and any appeals are resolved.

Why did this class action settlement happen?

The class action lawsuit claimed Aetna and Optum violated Employee Retirement Income Security Act and the terms of health plans by charging administrative fees that were not properly disclosed or permitted. Specifically, the plaintiff alleged Aetna misrepresented and misclassified Optum’s administrative fee as a medical expense, resulting in members and plans paying more than they should have.

Although Aetna and Optum denied all wrongdoing, they agreed to settle the case to avoid the uncertainty and expense of further litigation.

Sources

1. Long Form Notice
2. Settlement Agreement
3. Frequently Asked Questions