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Wilentz, Goldman & Spitzer, P.A. Files Lawsuit Against Aetna

WOODBRIDGE, NJ –Wilentz, Goldman & Spitzer, P.A. filed suit on July 30, 2007 in federal district court in Newark against Aetna on behalf of Michele Cooper, an Aetna subscriber. Ms. Cooper seeks to represent a nationwide class of Aetna subscribers.

The complaint in Cooper v. Aetna alleges that Aetna systematically underpaid benefits to its subscribers for medical and surgical services performed by out-of-network physicians, hospitals and other medical providers for the period July 2001 through the present by making invalid calculations of usual, customary and reasonable (“UCR”) amounts.

The complaint cited as an example the recent fine of nearly $10 million assessed against Aetna by the New Jersey Department of Banking and Insurance for using a percentage of Medicare rates to calculate UCR. This left Aetna subscribers financially exposed for out-of-network emergency services, contrary to state law. Use of Medicare rates to calculate UCR is one of several methods alleged in the Complaint which Aetna continues to use to systematically underpay its subscribers.

Wilentz, Goldman & Spitzer, P.A. is one of New Jersey’s oldest and largest law firms and has approximately 150 attorneys. In addition to its main office in Woodbridge, the firm also has offices in Eatontown, NJ, New York City, Philadelphia and Pittsburgh.