The following documents will help you understand your rights under the Humana settlement agreement (PDF requires Adobe® Reader®.
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How the Humana Inc. settlement agreement helps the physician practice (PDF, 136KB) contains a summary of the key business practices mandated in the Humana settlement. Since contracts provided by Humana to physicians in its provider network must conform to the Settlement, physicians are encouraged to review their contracts to ensure they are receiving available protections.
Pertinent information:
Date settlement reached by parties: Oct. 17, 2005
Final approval date: September 28, 2006
Value of settlements: In excess of $133 million
Retrospective relief: $40 million to Settlement Fund
Prospective relief: $75 million
The Health Net Settlement became effective September 28, 2006. Physicians who submitted a proof of claim form to Humana may expect payment in early 2007. We do not yet know the amounts that the settlement will pay individual class members.
Questions about the settlement may be directed to the Humana Physician Settlement Administrator at (866) 254-8048 or Whatley Drake & Kallas, L.L.C., at (866) 809-8003.
Compliance dispute facilitator (CDF)
Physicians may consider filing a “compliance dispute” if prohibited clauses are contained in a health plan’s contract or if the health plan fails to adhere to the terms of its settlement. After the dispute is deemed valid by the CDF, the CDF will act as the physician’s representative unless the physician or Signatory Medical Society, acting on the physician’s behalf, elects to employ separate counsel. Below is the contact information for the Humana CDF:
Carol Scheele
Associate General Counsel
North Carolina Medical Society
222 North Person St.
Raleigh, NC 27601
Phone: (919) 833-3836
Fax: (919) 833-2023
To learn more about foundations created by the settlements, please go to the Physicians Foundation Web site.
The HMO Settlements Web site was established in connection with this settlement among Humana, physicians and certain medical societies in the managed care litigation that is pending in the U.S. District Court for the Southern District of Florida.
For Humana dispute procedures, click on the links below:
Humana Step-by-Step Compliance Dispute Procedure (PDF, 20KB)
Humana Compliance Dispute Form (PDF, 25KB)
Humana settlement fund procedure
This summary has been prepared by the American Medical Association (AMA) Private Sector Advocacy unit from information provided to the AMA.Content provided by: Private Sector Advocacy