NU Online News Service, Dec. 11, 9:52 a.m. – A group of 19 state medical societies represented by the Texas Medical Association, Austin, Texas, is condemning a proposed settlement that CIGNA Corp., Philadelphia, recently negotiated to settle a class-action lawsuit filed in a state court in Illinois.
Doctors have been complaining about the way CIGNA and other managed care companies handle claims and allege the companies provide too little information about how they decide how much to pay for specific services. Lawyers are representing doctors in a major, national consolidated action against CIGNA and other large managed care companies in the U.S. District Court in Miami.
CIGNA said the Illinois settlement, which could resolve the CIGNA portion of the Miami litigation, would result in a payout of at least $50 million and substantial changes in the way it does business.
The societies represented by the Texas Medical Association say the Illinois proposal is “woefully inadequate.”
“The proposed settlement in the Kaiser vs. CIGNA case would bar almost all of the managed care claims against CIGNA pending in a class-action case being heard by U.S. District Judge Federico Moreno in Miami and in other state court actions,” the societies note in a statement.
Doctors would be better off achieving a settlement through the Miami action, which includes racketeering allegations as well as general complaints about claims-handling, the societies say.
Under the proposed Illinois settlement, CIGNA would still be able to use financial criteria to overturn the decisions of the treating physician when it comes to determining whether a given course of treatment was medically necessary for a patient, the societies say.
The Illinois settlement would also let CIGNA continue burdensome restrictions on how physicians practice medicine, as long as the company disclosed those restrictions publicly, the societies say.
The societies complaining include the state medical societies in Alaska, Arizona, California, Connecticut, Florida, Georgia, Hawaii, Louisiana, Maine, New Hampshire, New Jersey, New York, North Carolina, South Carolina and Tennessee, and county medical societies in Colorado, Virginia, and Texas.