CIGNA settlement deadline nearing
■ Doctors can make claims one of two ways.
By Tanya Albert amednews correspondent — Posted Feb. 7, 2005
If you haven't already, now is the time to finish getting claims together for the massive CIGNA Corp. settlement. Claims must be filed before Feb. 18.
An estimated 900,000 physicians are eligible for compensation from CIGNA, and doctors can go about it in two ways.
They can opt to be part of a $30 million fund to be divided among those who chose that option. By going that route, doctors don't have to find and submit documentation of claims they filed with CIGNA over 13 years. Even those who did not file a claim with CIGNA in that time but who filed with other health plans that are part of the massive litigation in that period are eligible to be part of the fund.
Physicians who don't want to share in a set amount of money can be part of the Claim Distribution Fund. Under that option, physicians have three ways to claim money, and they can make claims under all three areas.
First, physicians can submit paperwork showing that they faced denial or payment reductions for 1,200 different code combinations.
Second, physicians can submit claims for other codes that were unpaid or underpaid. Lastly, doctors can file paperwork showing claims for which they believe CIGNA improperly denied payment because the plan cited the treatment as medically unnecessary, experimental or investigational.
Individual physicians and several state and county medical societies sued the nation's largest HMOs for the way they paid doctors. Among other things, the physicians alleged that CIGNA and the others used computer programs that systematically rejected or downcoded claims.
The CIGNA settlement covers claims filed between Aug. 4, 1990, and Sept. 5, 2003. Aetna, Anthem, Coventry, Health Net, Humana, PacifiCare Health Systems, Prudential Insurance Co. of America, United Healthcare and WellPoint Health Networks also are defendants in the lawsuit. Aetna has settled its lawsuit. Suits against the other firms are set to go to trial in September.