Suit against HMO gets class action status

Physicians throughout the country could benefit from a lawsuit against CIGNA now moving through an Illinois court. But there are still legal hurdles to overcome.

By Tanya Albert, AMNews staff. Oct. 8, 2001.

While the much-reported lawsuits that physicians filed against the nation's largest HMOs slowly wind through federal court in Miami, a little-known lawsuit in an Illinois court has been quietly making big strides.

The suit didn't get bumped to federal court and tossed in with the dozens of suits in Miami. Instead, a Madison County, Ill., judge earlier this year certified the contract case that two physicians filed against CIGNA as a class action for the entire nation.

The ruling means that several hundred thousand physicians who had contracts with CIGNA have a stake in the case's outcome.

"This is a very significant case because it has implications nationwide," said AMA Trustee and Secretary-Treasurer Donald J. Palmisano, MD, "This is the only case in the country that has been certified as a nationwide class action."

Alton, Ill., otolaryngologist Timothy N. Kaiser, MD, and Irving, Texas, pediatrician Suzanne LeBel Corrigan, MD, filed suit in May 2000 against CIGNA in Madison County -- along the Mississippi River near St. Louis.

By design, the case deals with a very simple contract claim. "The problems that occurred are well-known to every physician: Dropped codes, downcoding, bundling," Dr. Kaiser said. "There were constant reimbursement difficulties. I simply got sick and tired of it."

The suit, Kaiser v. CIGNA, accuses the health plan of bundling and downcoding CPT codes. The contracts physicians signed don't address bundling or downcoding, according to the lawsuit. Consequently, the suit claims, CIGNA has breached their contract. "We have a very simple contract claim: Pay us for what we do," said Dr. Kaiser's attorney, Judy L. Cates. [...]