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May 22, 2003 at 08:00 PM
NU Online News Service, May 22, 2003, 12:50 p.m. EDT – Aetna Inc., Hartford, has hammered out a settlement with lawyers representing 700,000 U.S. doctors in a dispute over handling of managed care claims.
The agreement, which is subject to court approval, calls for Aetna to pay $100 million to the doctors, or about $140 per doctor.
The agreement also calls for Aetna to pay $50 million in legal fees, contribute $20 million to a health quality foundation, give doctors more information about how it pays bills, and set up an independent billing appeals process.
Aetna negotiated the agreement to resolve its share of the managed care lawsuits now being heard in Miami.
Lawyers began organizing suits against Aetna and other managed care companies in 1999. Lawyers for the doctors have accused carriers of conspiring to delay payments and deny valid claims.
A panel of federal judges transferred many of the cases to the U.S. District Court in Miami in October 2000. U.S. District Judge Federico Moreno declined in September 2002 to certify a class of plan members, but he did certify a class of doctors.
Dr. Donald Palmisano, president-elect of the American Medical Association, Chicago, suggests that the proposed Aetna settlement could serve as a model for other carriers. The association “expects this settlement to raise the bar for the entire health insurance industry on fair and open business practices,” he says.
