Cigna Settlement: A Call To Political Action?
- Volume 18 - Issue 2 - February 2005
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$11,550,000. That is the settlement fund that DPMs and other specialty care providers will be able to draw from after enduring years of billing disputes with Cigna Healthcare. In December, the insurer decided to settle a national class action lawsuit filed by specialty health care providers and associated state and national associations including the American Podiatric Medical Association (APMA).
How significant is the settlement? In terms of the immediate financial remuneration, one podiatrist calls it a “drop in the bucket” compared to the revenue the insurer has generated in total premiums over the years. While there are no exact figures on the number of clinicians covered by the settlement, it will reportedly cover a wide range of specialists including chiropractors, nurse practitioners, psychologists and optometrists just to name a few. When all is said and done, the podiatrist estimates that each clinician will receive “around $100, if that.” However, the APMA, a primary force in the lawsuit, notes that some practices may receive two to three times that amount depending on the number of claims they submitted to Cigna.
Aside from the short-term rewards, Cigna must take steps to enhance the clarity of its billing process. Reportedly, the insurer must:
• provide detailed information about its claim coding policies, fee schedules and other guidelines for participating specialty care providers via its Web site;
• limit reductions in fee schedules for participating specialists to once a calendar year;
• have an independent and external review process for resolving disputed claims; and
• create an advisory committee of health care specialists (including a podiatrist).
The increased clarity should facilitate proper claims paperwork the first time around.This would accordingly prevent wasted money and staff time on appeals over denied claims. According to an APMA press release, “the reduced administrative burden on practicing podiatrists is worth millions of dollars indirectly to APMA members.”
Will other insurers take notice? As one DPM points out, insurers were likely paying close attention to the settlement as they naturally would want to monitor their competitors’ products, coverage decisions and pricing.
However, other DPMs are less optimistic. A well-known podiatric educator says insurers may not be as “blatantly arrogant” as in the past. Another DPM, who has sued an insurance company, says “insurance companies will not change their behavior unless they are forced to do so.”
There are other avenues for addressing grievances. A podiatrist who often lectures and writes on insurance issues encourages fellow DPMs to have a strong understanding of the rules established by the Department of Labor under the Employment Retirement Income Security Act (ERISA). He says encouraging your state attorney general to enforce these rules can lead to a “whole new level of cooperation.”
Ultimately, this settlement shows it takes strength in numbers to achieve equitable reimbursement from insurers. Imagine what might happen if more podiatrists joined in the fight. Offering financial support to state and national associations is one step. Others advocate joining a state association and the APMA, and joining a committee to help facilitate more changes in insurance practices. Another step is actively challenging every claim you have been shortchanged on and filing complaints with your state insurance commissioner.
While there are varying views about the settlement, there is a common belief that the Cigna settlement is “just a skirmish in the whole battle for fair reimbursement and fair standards for claim processing.” By doing your part to enhance the strength in numbers, you can help create greater leverage and a louder unified voice that is difficult to ignore.