Family physicians have until Nov. 17 to request payment under a proposed WellPoint Health Networks/Anthem Inc. settlement agreement that would end a class-action lawsuit filed by physicians against health insurers.
The agreement stipulates that WellPoint set aside $135 million for distribution to physicians who submitted claims to WellPoint/Anthem between Aug. 4, 1990, and May 10, 2005. Physicians must send a proof of claim form (PDF file: 2 pages / 37.4 KB. More about PDFs.) to WellPoint/Anthem Physician Settlement Administrator, P.O. Box 3560, Portland, OR 97208-3560 before Nov. 17.
HMO Settlements, an online resource, provides links to the WellPoint/Anthem and other class-action settlements reached with health insurance companies. The resource provides filing instructions (PDF file: 2 pages / 31.7 KB. More about PDFs.) and claim forms (PDF file: 2 pages / 31.7 KB. More about PDFs.) on the WellPoint agreement.
The proposed settlement agreement would end litigation against WellPoint/Anthem in which physicians alleged that the named insurers conspired to reduce or deny physician payment through unfair business practices, including bundling, downcoding, rejecting the medical necessity of covered services, failing to recognize CPT modifiers, and failing to pay claims within the statutory or contractual time period.
Distribution of funds will occur only if the U.S. District Court approves the agreement. The court hearing on the settlement is scheduled for Dec. 2.
The WellPoint/Anthem settlement agreement is one of six agreements made in the class-action litigation. Aetna and Cigna, which have distributed funds to physicians involved in their agreements, are in the compliance phases of their settlements.
That compliance stipulates that Aetna and Cigna will refrain from bundling, downcoding, failing to pay within the contracted or legally established timeframe, and other actions prohibited in the settlement agreement. Physicians can report failure to comply with the agreement through Aetna's online compliance and billing dispute forms and Cigna's printable dispute form (PDF file: 2 pages / 34 KB. More about PDFs.).
