PROFESSION

Vigilance aids class-action claims

The more disputes that physicians file, the better case attorneys say they will have when trying to enforce compliance with the HMO settlement.

By Mike Norbut, AMNews staff. July 18, 2005.

Chicago -- Physicians, who were the engine behind the class-action lawsuits filed against the country's largest HMOs, also will be the most important compliance officers when it comes to ensuring the companies live up to their settlement agreements, attorneys representing the doctors in the lawsuits said last month.

Physicians and state medical society officials learned the latest details of their cases against insurance companies from the attorneys during a multi-district litigation conference at the American Medical Association Annual Meeting last month. Reaching settlement agreements with Aetna and Cigna Healthcare in 2003, it seems, was just the beginning of the battle, attorneys said.

Between fighting through red tape to receive money doctors have coming to them from the settlements and arguing about claims that have been denied, the administrative hassles are still very much a part of dealing with managed care companies, attorneys said.

Physicians, however, can help alleviate those hassles by being vigilant in recording their compliance disputes, said Nick Roth, a Decatur, Ala.-based attorney. Many doctors may be experiencing problems in receiving payments for their claims, but they aren't bothering to file appeals, Roth said. They either expect other physicians to file similar complaints, or they are dissuaded by the time-consuming process, he said.

"If we do start having these appeals, we get the history of overturned claims," Roth said. "That goes to the advisory boards, which makes a difference. It lets us go in and say there's a systemic problem."

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