opinion

United settlement: Helping doctors get their fair share

Winning a court agreement from UnitedHealth Group over faulty out-of-network pay was the first step. Helping doctors get appropriate payments is next.

Posted June 28, 2010.

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Organized medicine struck a deep blow against unscrupulous insurance payment tactics more than a year ago when it helped secure a $350 million settlement in a class-action lawsuit against UnitedHealth Group. The insurer was using the flawed Ingenix database to lowball out-of-network pay rates.

Now the clock is ticking for physicians to get their fair share of the settlement, and once again the American Medical Association is helping out.

By now, affected physicians should have received settlement notices that started being mailed in April. The notices stipulate that eligible doctors have until Oct. 5 to file claims with United. If any doctor has an objection to the settlement details or wants to opt out, he or she has until July 27 to make those intentions known.

But as is always the case with class-action settlements and other large-scale legal proceedings, the paperwork and processes involved can be quite complicated. There's no reason why legalese and documentation barriers should get in the way of physicians receiving what they are owed. After all, the staffs at physician practices are busy enough as it is, and they want to maximize the time that they have caring for patients, not filling out forms.

That's why the AMA has assembled an easy-to-follow online guide that physician practices can use to navigate the way to filing successful claims. By visiting the website, practices can follow step-by-step instructions to determine if they are eligible for monetary damages, assemble the necessary documentation and file claims (link).

With its instructional videos, downloadable forms and frequently asked questions, the website can serve as a one-stop shop for physicians who are affected by the settlement. And if a practice needs additional help with any aspect of the process, information on whom to contact is listed there, too.

The resources can help ensure that physicians who were harmed by United's systematic reduction of out-of-network rates will get what they deserve. And they will help hold the insurer fully accountable for having continued to use a flawed database year after year to shortchange doctors and their patients.

The $350 million agreement, which awaits final court approval in September, was a major victory for the Litigation Center of the American Medical Association and the State Medical Societies, which spent a decade fighting on behalf of physicians on this issue. It's no coincidence that when AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, cited the work of the center during the AMA Annual Meeting on June 12, the settlement was the first item that he mentioned.

The money available in the settlement is important for those hurt by United's attempt to make a profit at the expense of out-of-network doctors and their patients. But the issue goes far beyond the dollars in play. The other positive effects of the settlement won't just benefit those who were directly wronged by the insurer and who are eligible to receive a check.

Although it has not admitted wrongdoing, United has agreed to stop using the flawed Ingenix database and to fund a new, independent system that insurers can use to accurately set usual, customary and reasonable rates. By making those data public, never again will insurers be able to pull the wool over doctors' and patients' eyes as United and other insurers did in this case. The AMA and others in organized medicine will be watching closely to make sure that the Fair and Independent Research (FAIR) database lives up to its name.

The truly lasting legacy of this settlement will be for patients who want to keep seeing their favorite physicians, despite the fact that the doctors have chosen not to join some health plans' networks. Patients will be able to do so without fear that the insurers are using those decisions to take unfair advantage of both them and their doctors. That will continue long after the last physician has received his or her share of the landmark United settlement.

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