CIGNA settlement information

Alert! Review Your CIGNA Contracts Before September 4!  (PDF, 89KB)

The following documents will help you understand your rights under the CIGNA settlement agreement. (PDF files require Adobe® Reader®.
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How the CIGNA settlement agreement helps the physician practice flyer (PDF, 205KB) contains a summary of the key business practices mandated in the CIGNA Settlement. Since contracts provided by CIGNA 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.

PHYSICIANS CAN RESUBMIT PREVIOUSLY DENIED CAD MAMMOGRAPHY CLAIMS TO CIGNA

Thanks to the work of the medical societies involved with the Physicians Advocacy Institute (PAI), physicians may resubmit their previously denied CAD mammography claims to CIGNA.  This opportunity to resubmit claims is another victory resulting from the settlements in the national MDL class action lawsuits against the nation’s for-profit health plans.  PAI used the formal compliance dispute resolution process that was part of the CIGNA Settlement Agreement to require CIGNA to pay these claims. Claims can be resubmitted from June 1, 2007 through December 1, 2007.

Eligible claims must:

• Involve CPT® Codes 76082 or 76082 as add-on codes with 76090,    
  76091, or 76092 and
• Have been submitted  between January 1, 2004, when the CAD
  Mammography add-on codes became effective, and October 10, 2004,  when CIGNA began paying the claims. 

To resubmit claims, complete the Spreadsheet and e-mail it to CADMammoRebsubmit@CIGNA.com.  Questions may also be e-mailed to this address.   Physicians without access to e-mail can mail their completed spreadsheets to CIGNA R&R Department P&C, P.O. Box 9018, Sherman, TX 75091-9018 and can direct questions to the CIGNA Compliance Dispute Facilitator, Deborah Winegard, at (404) 881-8900.
 
Spreadsheet for resubmitting previously denied CAD Mammography claims.

Pertinent information:

Date settlement reached by parties: Sept. 3, 2003

Final approval date: Oct 22, 2004

Value of settlements: In excess of $540 million

Retrospective relief:$85 million

• $30 million to Category A Fund
• $40 million to Claims Distribution Fund
• $15 million to Foundation

Prospective relief: $400 million

Questions about the settlement may be directed to 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 CIGNA CDF:

Deborah J. Winegard
c/o Doffermyre Shields Canfield Knowles and Devine
1355 Peachtree St., Suite 1600
Atlanta, GA 30309
Phone: (404) 881-8900
Fax(404) 881-3007

To learn more about foundations created by the settlements, please go to the Physicians Foundation Web site.

A Web site was established in connection with this settlement among CIGNA HealthCare, 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 CIGNA dispute procedures, click on the links below:

CIGNA Compliance Dispute Procedure (PDF, 71KB)

CIGNA Filing Instructions (PDF, 94KB)

CIGNA Compliance Dispute Claim Form (PDF, 17KB)