Message from Tim Lee, TRTA Executive Director

Correcting Information Originally Provided Regarding Aetna Settlement

TRTA strives to provide the best, clearest, and most accurate information available on all issues pertaining to the Teacher Retirement System of Texas (TRS) and our members’ interests.

Last week, we learned about a class action lawsuit settlement between Aetna and those who have received payment or compensation for out-of-network coverage as part of their benefits through Aetna (the determined class of people represented by this legal settlement).

Based on the information we received, we developed an update that stated that a member receiving information from Aetna about the lawsuit did NOT have to do anything to be a participant in the class action settlement.

This information is inaccurate. A claimant wanting to participate in the class action settlement MUST complete the forms that are being provided by Aetna as part of this settlement.

A complete description of the action needed on those forms is provided in TRTA’s revised update below. If you have filed away your Aetna form, lost it, or just discarded it, you can download the forms by clicking here (http://nebula.wsimg.com/a7360ba6f4cbbba96355bb1e74f67fac?AccessKeyId=01F1A4624253D6F9587B&disposition=0). You may also choose to contact Aetna UCR Litigation to request an additional copy of the forms (1.800.600.3079).

I deeply regret and apologize for providing inaccurate information about this settlement. As I said, we take our role of providing accurate and timely information very seriously, and we are all disappointed in our service to you when we make mistakes.

We will work diligently to assure our members that mistakes like this are not made in the future.

Sincerely,

Tim Lee
TRTA Executive Director

(Begin TRTA Updated Article on Aetna Settlement)

Aetna Settlement in Lawsuit Impacts Some TRS Members: CORRECTED AND NEW INFORMATION

Last week, the Texas Retired Teachers Association (TRTA) sent out an Inside Line article regarding a lawsuit being settled by Aetna. As a member of the Teacher Retirement System of Texas (TRS) who participates in the TRS-Care medical insurance program, you may have received or may soon receive a notice from Aetna in the mail regarding this lawsuit.

A settlement under which Aetna agreed to pay up to $120 million has been given preliminary approval by the New Jersey District Court. The settlement relates to class action litigation over payments for out-of-network benefits. The litigation for this case began in 2007 over payments for out-of-network benefits. This litigation is known as MDL 2020 (originally filed under the plaintiff name Cooper).

Although our article was reviewed by parties with first-hand knowledge of the Aetna settlement prior to being published, additional information has established that some of the instructions provided by TRTA regarding how to receive payment from this settlement are INCORRECT.

If you received the lawsuit notice from Aetna, PLEASE READ THE CORRECTED INFORMATION PROVIDED BELOW. We have also included some NEW INFORMATION not previously provided.

Who is receiving this notice?

All Aetna policy holders whose benefit structure includes in-network and out-of-network benefits may receive this notice. The settlement is not limited to TRS-Care or Texas Aetna coverage. These notices are going out to Aetna policy holders nationally.

You may receive this notice if you used out-of-network providers and/or benefit options through TRS-Care at any time since 2001 and through 2013.

Anyone who receives the notice can partake in the Class Action Suit and can be reimbursed up to$40 per year (this amount may be less depending upon the number of people who accept the settlement proposal).

If I receive the notice, what should I do? (CORRECTED INFORMATION INCLUDED IN THIS SECTION)

In order to receive these reimbursements, you should NOT opt out. If you are affected by this settlement, you are automatically eligible to receive up to $40 per year in which you had eligible claims. In order to receive your settlement, you must select Option 1 on the Subscriber Claim Form. This should be on page 7 of the document you received. You should also complete pages 8 and 10 of the document. Return these forms to: Aetna UCR Litigation – Subscriber, c/o Berdon Claims Administration LLC, P.O. Box 15000, Jericho, NY 11853-0001.

The information you return to Berdon Claims must be postmarked no later than March 28, 2014.

Previously, TRTA instructions said you had to do nothing to receive this settlement. The CORRECT information is that you must select Option 1 and return that page (7) along with pages 8 and 10 to Aetna UCR Litigation with a postmark no later than March 28, 2014.

What if I need to submit a claim for extensive out-of-pocket expenses? (NEW INFORMATION INCLUDED IN THIS SECTION)

If you feel that your claims warrant more attention due to extensive out-of-pocket expenses, you would need to submit a claim and show proof of your balance billing activity. This would mean you would be opting out of the settlement and pursuing a personal claim. To do this, you must select Option 2 on the Subscriber Claim Form. Please note that you cannot select both options 1 and 2. Those completing Option 2 also need to complete and return pages 8, 9, and 10.

Those who qualify will receive between 3-5% of the allowed amount. As an example, if a plan paid out of network at 80% of regular and customary, and allowed $100 of a $150 charge, the member could get 3-5% of the $100 that was allowed. If it was a TRS member that was held to the proprietary fee schedule and may have been allowed $75, they would get 3-5% of the $75.

If you feel that you should submit a claim because of extensive out-of-pocket expenses, you should contact the Aetna class counsel. You can reach them by calling 1.800.600.3079 or Aetna UCR Litigation, c/o Berdon Claims Administration LLC, P.O. Box 15000, Jericho, NY 11853-0001.

The number provided above is not for the insurance company, but for the class counsel settlement team. The insurance company itself legally cannot assist in completing claims, but can provide assistance by printing Explanation of Benefits (EOBs) and claim information.

Members who submit claims must elect to recover from either the general fund ($40/year) or the fund requiring documentation. Members CANNOT recover from both funds.

I’m not sure if I had extensive out-of-pocket expenses. How do I learn more? (NEW INFORMATION)

Included in the document sent out by Aetna UCR Litigation on page 15 is a Claims Information Request Authorization Form. You may complete this form and return it to Aetna UCR Litigation to receive a copy of the claims information made available to the Settlement Administrator by Aetna in connection with this lawsuit.

You may also contact Aetna to receive EOBs and other claim information by calling 1-800-US-AETNA (1-800-872-3862).

Does this settlement have anything to do with the American Affordable Care Act?

This settlement is not related in any way to the Affordable Care Act (ACA or sometimes referred to as Obamacare). This settlement is part of a Class Action Lawsuit brought by various medical providers from the state of New Jersey, but does have national implications for all Aetna policy holders that have in-network and out-of-network benefits as part of their plans.

When can I expect to receive my payment if I qualify for this settlement?

Aetna has not yet provided a timeframe for when payments will be distributed. Because this is a proportional or pro-rata distribution, all claims will be paid at the same time. Since Aetna insures millions of people, they expect to receive a very large number of claims. This process may take a substantial amount of time. All claims are first reviewed and evaluated and then claimants with deficient claims are given a chance to cure them. After the Court approves the distribution, payments will be made to eligible claimants based on the Settlement administrator’s findings. Aetna asks for your patience at this time.

Will TRS-Care experience any changes in benefits or costs this plan year due to this settlement?

No.

Our Sincerest Apologies

TRTA knows that receiving information about class action lawsuit settlements can be both unsettling and confusing, and the article sent out last week contributed to this confusion. We apologize for providing you with the incorrect information and hope that the corrected information provided today is helpful to you.

IMPORTANT: If you read last week’s update and discarded the documents you received from Aetna UCR Litigation, please contact them as soon as possible to request an additional copy. You may reach them at 1.800.600.3079.

Finally, if you have any additional general questions about this settlement, please email us at info@trta.org and we will do our best to answer. Thank you for being a TRTA member. We appreciate your support! If you are not a member, please contact our office at 1.800.880.1650 and we will be happy to assist you with any membership questions you may have.