ASC Sues Aetna Over “Mystery Repricing Program”

Aetna repriced $233,988 to $33,380. Inquisitive minds want to know why………….

Florida ASC sues Aetna over ‘mystery repricing program’

Marcus Robertson – Thursday, October 14th, 2021  Print  | Email

Melbourne, Fla.-based Surgery Center of Viera sued Aetna on Oct. 13, according to court documents. The lawsuit alleges that Aetna used an undisclosed “mystery repricing program” to reimburse Viera $33,380 for a July 2018 spinal procedure that the ASC says cost $223,988.

Viera considered the operation to be medically necessary for the patient, who was covered under a corporate plan administered by Aetna under the Employee Retirement Income Security Act, according to court records. Aetna approved a prior authorization for the procedure, the complaint said.

Viera’s lawsuit aims to force Aetna to disclose the repricing guidelines it used. ERISA penalizes insurers up to $110 per day for withholding administrative details from suppliers, and Viera looks to be awarded more than $89,000 over Aetna’s alleged refusal to disclose the information, according to court records.

Surgery Center of Viera has previously filed two similar suits against Cigna and Aetna subsidiary Meritain Health.

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