Judge OKs CIGNA settlement with doctors
■ Negotiations continue with other managed care companies.
By Tanya Albert amednews correspondent — Posted Feb. 23, 2004
A federal judge gave the final stamp of approval to a deal struck between CIGNA HealthCare and the nation's 700,000 physicians that settles a lawsuit in which physicians claimed the plan did not pay them fairly.
The move means that the health plan will continue making changes to the way it reimburses physicians and proceed with plans to compensate doctors for past claims.
In all, CIGNA estimated that physicians would receive a minimum of $85 million in cash. But CIGNA and doctors say the nonmonetary portion of the settlement will have an even bigger impact on physician practices.
This is the second settlement of its kind. Aetna Inc. settled a similar lawsuit last year.
"CIGNA should be commended for standing up and agreeing to a settlement that sets a new standard for the industry and demonstrates CIGNA's openness and support of physicians and their patients," said Tim Norbeck, the Connecticut State Medical Society's executive director.
Under the agreement, CIGNA, in part, will follow standard CPT codes, use standard clinical definitions of medical necessity, limit physician fee schedule changes to one per calendar year, establish an e-mail procedure that lets physicians ask questions about fee schedules and claim coding, and contribute $15 million to a state medical society-run foundation established for public health improvement initiatives.
"Today's action by the court is a prescription for a stronger, more collaborative working relationship between doctors and CIGNA," CIGNA's chief medical officer, W. Allen Schaffer, MD, said in a statement.
Nearly two dozen state and local medical societies and the AMA endorsed the settlement.
U.S. District Court Judge Federico Moreno in the Southern District of Florida approved both the CIGNA and Aetna agreements. He is still overseeing similar class-action lawsuits against Anthem Blue Cross and Blue Shield, Coventry Health Care Inc., Humana Inc., Prudential Insurance Co. of America, United Healthcare Inc. and WellPoint Health Networks Inc. The lawsuits are expected to go to trial in the fall, but insurers await an 11th U.S. Circuit Court of Appeals ruling on whether they will go forward as class actions.