Family physicians who have contracts with Humana Inc., or its subsidiaries should watch their mailboxes for a notice of proposed settlement in a class-action lawsuit against the Louisville, Ky.-based insurance company.
The notice announces an Oct. 18 settlement agreement between Humana and physicians involved in the class-action suit.
The physicians allege the defendants, which include a number of managed care companies, conspired to reduce or deny physician payment through several means, including bundling, downcoding or rejecting the medical necessity of covered services. The companies named in the lawsuit also are alleged to have routinely failed to recognize CPT modifiers or to pay claims within the statutory or contractual time period.
If approved by the court, the agreement would conclude the lawsuit against Humana, which is scheduled for trial on April 17, 2006.
According to a press release (PDF file: 2 pages / 22 KB. More about PDFs.) about the settlement, the agreement stipulates that Humana will establish a $40 million fund to pay physicians whose claims were denied or underpaid by Humana between Aug. 4, 1990, and May 10, 2005. It also requires the company to change its business practices, increase the transparency of those practices and improve communication with physicians.
"The settlement will improve transparency and provisions in physicians' contracts" with Humana and the other companies that have reached an agreement in the lawsuit, said Trevor Stone, AAFP manager of private sector advocacy. A model contract (PDF file: 68 pages / 857 KB. More about PDFs.) for managed care, which includes supplements and a discussion of key contract issues, is available free from the AMA.
Humana is the sixth for-profit company to settle in the lawsuit. Previous agreements were reached with WellPoint/Anthem, Health Net, Prudential Insurance Company, Aetna and CIGNA Corp.. Still in litigation are Coventry Health Care, Pacificare Health Systems, Inc., and UnitedHealthcare.
The deadline for participating in the proposed settlement in the lawsuit against WellPoint/Anthem is Nov. 17. Physicians can go to the WellPoint/Anthem instructions (PDF file: 2 pages / 31.7 KB. More about PDFs.) for filing a claim or to get more information.
