The Aetna OptumHealth settlement resolves a decade-long class action, Peters v. Aetna Inc., for roughly $8.35 million. If you were enrolled in an Aetna ERISA health plan and received chiropractic or physical therapy services through Optum’s provider network on or after July 12, 2012, you are likely a class member. A federal court in the Western District of North Carolina granted final approval on September 4, 2025, and most eligible members do not need to file anything to receive payment.1Healthcare Dive. Aetna, Optum Dummy Codes Settlement
Who Qualifies for a Payment
The settlement covers two groups of people who were part of ERISA-governed health plans insured or administered by Aetna and who received chiropractic or physical therapy through Optum’s network after July 12, 2012.2Aetna Optum Admin Fee Settlement. Settlement Homepage
- The Member Class covers plan participants who personally paid too much in coinsurance because the coinsurance was calculated using an inflated rate.
- The Plan Class covers participants in self-insured Aetna plans where the plan itself overpaid on those claims.
The settlement FAQ lists affected plans in North Carolina, South Carolina, Georgia, Virginia, Illinois, Indiana, and the District of Columbia.3Aetna Optum Admin Fee Settlement. FAQs4Fierce Healthcare. Aetna, Optum Agree to Settle Decade-Long Dummy Codes Case5Law360. Aetna, Optum to Pay $8.3M to End ERISA Fee Suit
How Much You Can Expect
Payments are not a flat amount. Each class member’s share is based on the difference between the inflated agreed rate that Aetna and Optum used and the provider’s actual contracted rate for the treatment. Individual claims are capped at $5,000 for calculation purposes, and any payment that would come out under $15 is not issued.3Aetna Optum Admin Fee Settlement. FAQs
The $4.8 million settlement fund, after a $20,000 incentive award to named plaintiff Sandra Peters and $52,400 in administration costs, is split evenly between the Member Class and the Plan Class. If Member Class claims total less than $2.4 million, everyone gets 100% of their calculated amount. If claims exceed that, payments are prorated.6ClassAction.org. Peters v. Aetna Inc. Settlement Agreement
Whether You Need to File a Claim
For most people, no. Claims for services received between July 12, 2012, and December 31, 2017, are calculated automatically from Aetna’s own records, and eligible class members receive their share without submitting anything.3Aetna Optum Admin Fee Settlement. FAQs
Claims for services after December 31, 2017, worked differently. To qualify for those, a class member had to show that their Aetna plan document at the time did not disclose that the “allowed amount” could include an administrative fee. Supporting documentation was due by July 10, 2025, and that deadline has passed.3Aetna Optum Admin Fee Settlement. FAQs
The opt-out window has also closed. By the deadline, only 12 people had excluded themselves, and one objection was filed.4Fierce Healthcare. Aetna, Optum Agree to Settle Decade-Long Dummy Codes Case
When Payments Go Out
The court entered final approval on September 4, 2025.1Healthcare Dive. Aetna, Optum Dummy Codes Settlement Under the settlement agreement, Aetna and Optum must deposit their payments within 30 days after the approval order becomes final, which happens 35 days after entry of judgment if no appeal is filed.6ClassAction.org. Peters v. Aetna Inc. Settlement Agreement No specific check-distribution date has been publicly announced. The settlement website states that payments will be made after final approval and the resolution of any appeals.
How to Contact the Settlement Administrator
The administrator is Atticus Administration LLC. You can reach them at 1-800-322-1070, by email at AetnaOptumAdminFeeSettlement@AtticusAdmin.com, or by mail at Aetna Optum Admin Fee Settlement Administrator, c/o Atticus Administration, PO Box 64053, St. Paul, MN 55164.2Aetna Optum Admin Fee Settlement. Settlement Homepage If you believe you are a class member and have moved since receiving Aetna coverage, updating your mailing address with the administrator is the practical step to make sure a check reaches you.
Background on the Dummy Codes Allegation
Sandra M. Peters sued Aetna and OptumHealth Care Solutions in June 2015 in the U.S. District Court for the Western District of North Carolina. She alleged that Aetna hired Optum to manage its chiropractic and physical therapy provider network, and that the two companies agreed to add fabricated service codes, called “dummy codes” in court filings, to patient bills so Optum’s administrative costs could be built into the reimbursement.1Healthcare Dive. Aetna, Optum Dummy Codes Settlement
Because patient coinsurance was calculated on the inflated figures, plan members paid more out of pocket than their plan terms permitted. Aetna reportedly admitted to North Carolina state regulators that it had directed Optum to submit the dummy codes so Aetna could avoid paying the administrative costs from its own funds.7Healthcare Finance News. Aetna, Optum Pay $8.4 Million to Settle Dummy Codes Lawsuit Peters brought her claims under the Employee Retirement Income Security Act (ERISA), which is why enrollment in an ERISA-governed plan is a condition of class membership. The parties settled in December 2024 after nearly ten years of litigation, and the court granted preliminary approval in March 2025 before final approval that September.4Fierce Healthcare. Aetna, Optum Agree to Settle Decade-Long Dummy Codes Case