A record-breaking settlement has been reached between the American Medical Association, et al. and UnitedHealth Group—the nation’s largest health insurer— for 15 years of artificially low payments for out-of-network services. More than $350 million has been allocated to compensate impacted providers and subscribers, including doctors of chiropractic and their patients, according to the American Chiropractic Association (ACA).
Affected providers and subscribers should have received mailings from UnitedHealth Group that include an overview of the settlement, instructions for filing a claim for payment and proof of claim forms. Claims for payment must be filed by Oct. 5, 2010. Anyone filing objections to the settlement or opting out of the settlement must do so by July 27, 2010.
Evidence of UnitedHealth Group’s improper business practices was confirmed after an investigation by New York Attorney General Andrew Cuomo over allegations that a database operated by Ingenix, Inc., a wholly-owned subsidiary of UnitedHealth Group, intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures and the lack of audits. The Attorney General found that having a health insurer determine the “usual and customary” rate – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward. The creation of a new database, independently maintained by a nonprofit organization, is designed to remove this conflict of interest.
The settlement will be finalized at the United States Courthouse, United States District for the Southern District of New York on Sept. 13, 2010.
For more information about this settlement, the New York State Attorney General has made background information about the investigation and the settlement available online. In addition, Berdon Claims Administration LLC and the American Medical Association (AMA) have answers to frequently asked questions, detailed “next steps” and links to more information on their Web sites. Finally, AMA has developed a step-by-step guide for providers who are looking to maximize their recovery from the settlement