AMA helps doctors recoup from United settlement

An online guide assists physicians in claiming compensation from a $350 million settlement with the nation's largest health insurer over alleged suppression of out-of-network payments.

By — Posted May 3, 2010

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Physicians looking to get their fair share of a $350 million settlement with UnitedHealth Group over its allegedly flawed payment system can get help from a new online guide created by the AMA.

The January 2009 agreement resolved a class-action lawsuit against the nation's largest insurer for allegedly manipulating a database it ran through its subsidiary, Ingenix, to systematically reduce out-of-network reimbursements to doctors and patients. United admitted no wrongdoing.

Settlement notices were mailed to physicians beginning April 16, and doctors have until Oct. 5 to file a claim for compensation.

The AMA online guide, launched April 21, provides details on:

  • Determining eligibility for money damages.
  • Filing a claim.
  • Gathering supporting claim documentation.

The website also includes copies of claim forms and a list of plans included in the settlement (link).

In addition to the financial restitution, the settlement included meaningful business reforms from which "every physician and patient will benefit," AMA President J. James Rohack, MD, said in a statement.

The Litigation Center of the American Medical Association and State Medical Societies, along with medical societies in New York and Missouri, sued United in 2000 on behalf of physicians over the alleged payment abuses. That case, and a separate but related investigation by New York Attorney General Andrew M. Cuomo on behalf of consumers, led to the 2009 settlement, in which United agreed to stop using Ingenix, fund a replacement and establish other transparency measures. Other major insurers were included in the settlement but also denied any misconduct.

A new, independent database, dubbed FAIR (Fair and Independent Research), was announced by Cuomo in October 2009. The system, expected to be up and running this fall, will allow for public access to insurers' so-called usual, customary and reasonable rates for medical services.

A hearing to determine final approval of the settlement is set for Sept. 13 in U.S. District Court in New York. Doctors have until July 27 to file any objections to the settlement or opt out.

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