AMA: Docs Can File Claims Against Payer
The American Medical Association has set up a Web site to help thousands of physicians file claims against insurer UnitedHealth Group, which in January settled an AMA-filed lawsuit for $350 million.
The American Medical Association has set up a Web site to help thousands of physicians file claims against insurer UnitedHealth Group, which in January settled an AMA-filed lawsuit for $350 million.
The suit was one of at least four the AMA and several state medical societies have filed against insurers that used databases from Ingenix Inc. to price out-of-network claims. Ingenix is a subsidiary of Minneapolis-based UnitedHealth Group. Suits also were filed against Aetna, Cigna and WellPoint. The suits alleged that the insurers conspired for 15 years to underpay physicians for out-of-network services.
At least 10 national or regional insurers have reached agreement with New York Attorney General Andrew Cuomo to stop using the Ingenix databases and contribute a total of nearly $100 million to fund creation of an independent national database to process out-of-network claims. Cuomo charged the database intentionally skewed downward the "usual and customary" rates on which reimbursement was determined.
Under the AMA's settlement with UnitedHealth Group, the insurer will set up a $350 million fund to reimbursement members of the class action lawsuit. The deadline for physicians to file a claim to share in the fund is Oct. 5, 2010. For more information, click here.
--Joseph Goedert
The suit was one of at least four the AMA and several state medical societies have filed against insurers that used databases from Ingenix Inc. to price out-of-network claims. Ingenix is a subsidiary of Minneapolis-based UnitedHealth Group. Suits also were filed against Aetna, Cigna and WellPoint. The suits alleged that the insurers conspired for 15 years to underpay physicians for out-of-network services.
At least 10 national or regional insurers have reached agreement with New York Attorney General Andrew Cuomo to stop using the Ingenix databases and contribute a total of nearly $100 million to fund creation of an independent national database to process out-of-network claims. Cuomo charged the database intentionally skewed downward the "usual and customary" rates on which reimbursement was determined.
Under the AMA's settlement with UnitedHealth Group, the insurer will set up a $350 million fund to reimbursement members of the class action lawsuit. The deadline for physicians to file a claim to share in the fund is Oct. 5, 2010. For more information, click here.
--Joseph Goedert
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