Profession

CMA warns of "filing assistance" in WellPoint suit

Doctors should be leery of any company charging high fees to aid them in submitting claims in class-action suits against insurers.

By Mike Norbut — Posted Nov. 14, 2005

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Physicians planning to submit claims as part of the class-action settlement with WellPoint should be wary of companies offering their filing assistance for exorbitant contingency fees, the California Medical Assn. warned.

CMA officials learned of the solicitations after a few doctors received e-mails from a company offering its services, spokeswoman Karen Nikos said. The company offered filing assistance for a contingency fee of up to 35% of the reimbursement a doctor would receive, officials said.

WellPoint was one of 10 original defendants in the class-action case doctors brought against the nation's largest HMOs. Physicians allege that the HMOs conspired to systematically underpay physicians by downcoding and bundling claims. They accuse the health plans of violating federal civil law under the Racketeer Influenced and Corrupt Organizations Act.

Seven of the original defendants have settled physician claims, but three insurers have not. The remaining insurers are scheduled to go to trial in January 2006.

WellPoint's settlement with doctors was valued at about $198 million, including $135 million in compensation for past claims. The settlement resolves claims against both WellPoint Health Networks and Anthem, which had merged since physicians filed class-action lawsuits.

While the CMA has warned its members of one company soliciting physicians, AMA officials said they had heard of others attempting a similar scam related to other settlement agreements.

Physicians should check with their state medical societies for recommendations before signing up with a filing assistance company, officials said.

The WellPoint claims process is actually simple and fairly self-explanatory, CMA officials said. Physicians who wish to submit claims only need to select the three-year period in which they received the highest income from WellPoint or Anthem and choose the proper category for their range of income.

Those who were paid directly by the insurers do not need claims documentation, while those paid by an IPA or other physician organization need to supply some supporting documents. Physicians have until Nov. 17 to file their claims.

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External links

California Medical Assn. on the WellPoint settlement (link)

HMO settlements information (link)

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