Aetna and Optum have agreed to pay close to $8.4 million to settle a lengthy legal battle over so-called "dummy codes."
Aetna will pay the bulk of the settlement, contributing $4.6 million to the class and $3.55 million for attorneys' fees. Optum Health will contribute $200,000 to the settlement, according to court documents.
The lawsuit was first filed in the Western District of North Carolina in June 2015 and alleged that Optum and Aetna passed administrative costs on to patients as medical codes, or "dummy codes," that drove up their out-of-pocket costs. Per the lawsuit, Sandra Peters initially filed the complaint after seeing an unexpected spike in her costs for chiropractic and physical therapy services.
The lawsuit alleged that Aetna colluded with Optum Health as a subcontractor to apply additional service codes that covered the administrative costs.
Over time, the class action that signed on to the lawsuit grew to more than 256,000 people, according to the court docs.
Aetna declined to comment on the case. Optum had not responded to a request for comment at the time of publication.
The insurers initially scored a win in the case when the court ruled in their favor in 2019. That decision was overturned by the 4th Circuit Court of Appeals, which sent the case back down to be reconsidered.
An initial settlement agreement was reached in December 2024, averting a trial date set for early this year. The courts granted preliminary approval for the settlement in March, with outreach to class members beginning at that time.
Class participants had until July 10 to either opt out or object to the settlement, with just 12 opt-outs and one challenge. The individual who objected did not appear to be a member of the class themselves, but the spouse of a class member who did not object.