Check your mailbox. If you provided covered out-of-network services to patients insured by UnitedHealth Group between March 1994 and November 2009, you may be eligible to receive payments as part of a $350 million settlement reached last year.
The American Medical Association estimates that thousands of physicians will be eligible to be paid under the settlement. Notices with instructions for filing claims were mailed in May.
The $350 million settlement comes after a nearly decade-long legal battle between UnitedHealth Group and several plaintiffs, including the AMA, the Medical Society of the State of New York, and the Missouri State Medical Association. The groups alleged that UnitedHealth Group conspired to systematically underpay physicians for out-of-network medical services by using an industry database of charges to justify lower reimbursements.
Last year, UnitedHealth Group reached a settlement with New York State Attorney General Andrew Cuomo to discontinue use of the database and the company committed $50 million to fund the development of a new, independent database that will determine the rates paid for out-of-network care.
In a separate settlement, the company agreed to pay $350 million to reimburse health plan members and out-of-network providers who were underpaid as a result of the flawed database calculations.
Physicians and patients have until July 27, 2010, to opt out of the settlement. Claims for payments from the settlement fund are due by Oct. 5, 2010.
To be eligible to receive part of the settlement, physicians must have provided covered out-of-network services or supplies between March 15, 1994, and Nov. 18, 2009, to patients covered by a health plan that was either administered or insured by UnitedHealthcare, Oxford Health Plans, Metropolitan Life Insurance Companies, American Airlines, or one of their affiliates. In addition, in order to be eligible, physicians must have been given an assignment by the patient to bill the health plan.
Physicians billed via an assignment if they received a payment directly from the health plan, if they completed box 13 on the HCFA/CMS 1500 form, or if they marked yes in the benefits assignment indicator on an electronic health care claim.
Physicians who are owed money by a patient for a covered out-of-network service or supply cannot file a claim through the settlement; however, they can contact the Settlement Claims Administrator to find out if any of their patients have submitted claims to the settlement fund.
For more information, contact the Berdon Claims Administration LLC at 800-443-1073 or firstname.lastname@example.org