HMO Settlement Compensation Notice Mailed to Physicians

Physicians seeking compensation under the terms of the settlement of the national litigation against CIGNA must file their claims by February 18, 2005.

Physicians who provided covered services for CIGNA members from August 4, 1990 to September 5, 2003 and submitted claims to CIGNA HealthCare and its entities are considered part of the class eligible for compensation under the terms of the settlement.

As part of the relief offered by the settlement, members of the class can seek monetary compensation from two separate funds: the Category A Settlement Fund or the Claim Distribution Fund, which includes compensation related to coding, bundling edits, and medical-necessity denials. 

To be eligible for compensation from either fund, class members must submit Proof of Claim forms between August 23, 2004 and February 18, 2005 (February 8, 2005 for electronic submitters).  

Class members filing a Category A claim cannot also seek compensation from the Claim Distribution Fund.  

Category A Settlement Fund

The Category A Settlement Fund consists of $30 million in aggregate.  Physicians filing Category A claims for a proportionate share of the fund can have the payment directed to them personally, to a CIGNA-established foundation dedicated to promoting high-quality health care, or to a foundation established by a state medical society. (For information on the MMS and Alliance Charitable Foundation go to http://www.massmed.org/pages/foundation.asp)

Claim Distribution Fund

This uncapped fund will pay three categories of compensation, as follows:

• Category One Compensation: A list of specific code combinations that qualify for Category One Compensation is available at www.hmosettlements.com
• Category Two Compensation: Physicians may resubmit claims they believe were improperly denied and/or reduced. These claims may include but are not limited to the code list for Category One, and they may fall outside the time periods on the Category One list.
• Medical Necessity Denial Compensation: Physicians may resubmit claims they believe were improperly denied as not medically necessary or as experimental or investigational.

To read the notice and download the appropriate forms, go to www.hmosettlements.com and select “CIGNA”. 

Questions can be directed to Dana Cooper, manager, MMS Health Systems, at 781-434-7218 or dcooper@mms.org