Utah Chiropractic Physicians Association

The Utah Chiropractic Physicians Association needs you and your Chiropractic Friends to notify us of any requests for money back from Aetna, for any reason! Dr. Knight jknightut@juno.com

We are moving toward joining the Aetna Class Action Lawsuit. This is the kind of information that we need documentation for: 1. Challenge how Aetna determines the usual, customary and reasonable (”UCR”) rates for services provided by out-of-network chiropractors.

2. Challenging Aetna denying services for Intersegmental Traction, Surface EMG, Dry Hydro therapy, or any other serice that is traditionally done in Chiropractic Offices that is being denied because they purportedly have not been demonstrated to be safe and effective. 3. Also evidence of any refunds being asked for relating to the above challenges.

Your timely documentation of activities of this kind would be greatly appreciated.

James D.Knight,D.C. Member of Utah Chiropractic Licensing Board Chairman UCPA Legal Legislatice Committee  
Attorney Brian Hufford, a partner at a New York law firm with an office in Columbus, Ohio, is working on class action lawsuits against Aetna and Cigna alleging that the companies have denied payments for chiropractic services pursuant to their health care plan’s experimental and investigation exclusion.  UTAH DC’s who have experienced take-backs or care denials from Aetna or Cigna which are related to the experimental or investigation exclusion should contact the UACP at
In addition to these issues, Mr. Hufford is challenging how Aetna determines the usual, customary and reasonable (“UCR”) rates for services provided by out-of-network chiropractors.  In making its UCR determinations, Aetna uses a database it has licensed from Ingenix, Inc., a wholly-owned subsidiary of United Healthcare Group.  Mr. Hufford was co-lead Counsel on behalf of the American Medical Association in an action against United Healthcare claiming that the Ingenix database is inherently flawed and cannot provide a valid basis for setting UCR rates.
The lawsuit led to a probe into the independence of the Ingenix database by New York Attorney General Andrew Cuomo.   In January, UnitedHealth struck an agreement with Attorney General Cuomo to give its control of the Ingenix database to a public health school, which will create a new database under the oversight of the Attorney General’s Office.  United Healthcare also agreed to pay $50 million toward the funding of the new database, to which $20 million will be added from Aetna, pursuant to its own agreement with the Attorney General.  In addition, Mr. Hufford’s firm has negotiated a $350 million settlement fund to resolve the class action, which is currently being evaluated by the New York District Court for preliminary approval.  Last year, the District Court in New Jersey approved a similar settlement with Health Net, valued at $250 million, based on claims asserted by Mr. Hufford and his co-counsel, arising from Health Net’s reliance on the Ingenix database to set UCRs.
The effects of these lawsuits and judgments continue to ripple through the medical community.  Another class action lawsuit led by the American Medical Association alleges that the largest health insurer, WellPoint, also used the flawed database to undercut payments to physicians.  The suit, brought by the AMA, four state medical societies, and two California doctors, charges that WellPoint based its payment rates for non-participating or out-of-network physicians on skewed data from the flawed database. 
UACP leadership has been in contact with groups affected by this litigation and will continue to monitor future developments.  If your practice has been impacted by the insurance actions, please contact Tim Apgood, UCPA Executive Director  801-281-4100  tim@fscpa.net

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