NU Online News Service, Dec. 13, 2004, 5:26 p.m. EST
A Bloomfield, Conn., managed care company has negotiated an agreement that could resolve litigation with 210,000 providers of specialty health care.[@@]
CIGNA HealthCare, a unit of CIGNA Corp., Philadelphia, says the proposed provider settlement is similar to an earlier settlement it negotiated with lawyers representing a class of more than 700,000 doctors.
Lawyers have filed suits accusing CIGNA and other managed care companies of working together to lower and delay payments to doctors and other care providers in unreasonable ways.
The courts have consolidated the litigation in Miami under U.S. District Court Judge Federico Moreno.
Moreno must approve the proposed provider settlement before it can take effect.
The proposed settlement class includes acupuncturists, audiologists, chiropractors, counselors, nurse anesthetists, nurse midwives, nurse practitioners, nutritionists, optometrists, orthotists, physical and occupational therapists, podiatrists, psychologists, speech and hearing therapists, and others, CIGNA says.
The current proposed settlement calls for CIGNA to establish an $11.55 million compensation fund. Each provider’s compensation will depend on the amount of claims the provider has sent to CIGNA over the past 15 years.
The settlement also calls for CIGNA to:
- Improve specialty health care claims processing and adjudication.
- Improve Web-based claims management capabilities for specialty health care providers.
- Give specialty health care providers more information about claim coding policies and fees over the Internet.
- Avoid cutting fees for specialty health care more than once a year.
- Set up an independent review process for resolving billing disputes.
- Establish a specialty health care provider advisory committee.