Aetna's fourth-quarter net income sank 49 percent as higher medical costs squeezed profitability for the insurer's commercial health coverage, and several one-time expenses chipped away at the bottom line.

The Hartford, Conn., company said Thursday the amount it paid in medical claims grew more than 9 percent in the quarter to $6.12 billion as a rise in flu-related expenses countered a drop in use when Superstorm Sandy swept up the East Coast last fall.

This flu season has stirred worry among managed care investors about a rise in claims due to its early start and rapid spread. Aetna Chairman and CEO Mark Bertolini said earlier this month the insurer had seen a spike in flu intensity following two very mild seasons, but he didn't expect claims to exceed the insurer's normal range of $40 million to $50 million.

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