You may already be familiar with the law suit and finally tools are here to help out.  I briefly looked through some of the information and in some cases if you are a imagemember of an IPA, they could be handling some of the paper work for you so best is to check and see what is happening at that level.  It also looks like they will calculate for you the amount that is due with selecting an automated calculation.   The link below shows the initial announcement from December 2009.

AMA Announced Settlement of Class Action Suit of $350 Million with Ingenix (United Healthcare)

There is a PDF file available for download as well as all the claim forms on the site.  The information here is for UnitedHealthCare claims only and due to the fact that other carriers used the same “Ingenix” data base I would assume separate claim information will be released on how to file with other insurers.  Full information can be found at the link below. 

AMA Health Insurer Settlement Information

There was a variance of dates as to when carriers decided as to when they discontinued use of the Ingenix data base as HealthNet made their announcement in June of 2009 and had paid some claims at 14% higher than the data base called for. 

Health Net Agrees to Stop Using Ingenix Database for Calculating Reasonable and Customary Fees

There are additional lawsuits filed and pending relative to the same Ingenix data base filed in other states that are separate and not part of the AMA suit.  Those are different and I did a short summary few months ago on a few of those, so don’t confuse one of the other suits with the one filed by the AMA as they are different.

Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana

15 years of deflated payments is a long time and I hope there’s enough in the till to cover everyone who files.  It’s all about those “algorithms” or formulas used to calculate accurate or “desired” results that we have to deal with. 

This just also goes to reinforce the need for reading up and getting Legislators in place who have some idea of how technology is growing and how it is used to gain profit, not only with healthcare, but on Wall Street too, the ones who have substantially capitalized on using “those algos” as any broker will tell you.  With transparency we will continue to probably hear more of such in the news as not only healthcare practices catch up but also the infrastructure of our government which is in bad need of upgrades and servers all over the place after a number of years on “snooze” control under the past administration. 

We need good algorithms to successfully audit and regulate from our end so we don’t have big class action settlements needed like this in the future, but rather have the data ability to recognize it with the onset in the future.  This is great to be able to recoup but unfortunate on the other hand with adding some additional administrative work to recover the funds.  BD

“Beware of Geeks Bearing Formulas”…Warren Buffett

From the press release:

The American Medical Association (AMA) today launched a new online resource that will help thousands of physicians file claims in the record-breaking settlement reached in the AMA legal victory against UnitedHealth Group -- the nation's largest health insurer. More than $350 million is available to help compensate physicians and their patients for 15 years of artificially low payments for out-of-network services.

"The AMA is offering its support to physicians who are now receiving mailings containing details and claim forms regarding the historic UnitedHealth settlement," said AMA President J. James Rohack, M.D. "The new AMA guide provides physicians with step-by-step assistance in determining eligibility, assembling documentation and filing a claim under the terms of the settlement."

During the last decade, the AMA worked diligently with the Medical Society of the State of New York, the Missouri State Medical Association, the courts and regulators to expose and prohibit a price-fixing scheme used by UnitedHealth and other health insurers to underpay physicians and patients for out-of-network care.

July 27 - Deadline for filing objections to the settlement or for opting out of the settlement.

September 13 - Date for the final settlement hearing to consider any filed objections.

October 5 - Deadline for filing a claim to share in the settlement fund.

In addition to the information available in the new settlement guide, the AMA offers members personal assistance from the AMA's Practice Management Center if they have questions about the settlement or filing a claim form. AMA members interested in retaining a claims submission service can obtain a discounted rate offered by the Managed Care Advisory Group. - AMA Offers Physicians Help Claiming Damages From UnitedHealth Settlement

Related Reading:

“Fair Database” to Replace Unfair Ingenix Data Base – Run by Non ...

Chiropractor Files Class Action Breach of Contract Lawsuit Against ...

The Ingenix Inquisition – Hearing Requested by ...

Is this a case for a new law – illegal algorithms? how do you sleep at night


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