Special Issue

The Blue Cross Settlement: Hang in There

The Texas Medical Association believes it makes good sense for physicians to participate in the settlement of the federal class action antiracketeering lawsuit against Blue Cross and Blue Shield, file a claim for past harm, and use the settlement's enforcement process to make sure Blue Cross adheres to the settlement terms. Physicians who opt out of the settlement are not eligible to receive the benefits of the settlement's retrospective (monetary) relief from previously unpaid claims and are not entitled to the prospective relief from changes in Blue Cross business practices. Consult your attorney and financial advisor if you're not sure what to do.

The Blue Cross litigation (which includes Blue Cross and Blue Shield of Texas), along with the other antiracketeering lawsuits against HMOs, focused on the prospective relief, changing how Blue Cross and the other carriers do business. TMA believes physicians and physician practices should review the settlement carefully and evaluate all of the settlement benefits, especially the prospective relief, i.e., the new coding and payment provisions to which Blue Cross must adhere. You need to consider that in determining your next step.

Physicians who do nothing by Friday, Sept. 14, the deadline for acting if you do want to opt out, will automatically remain part of the settlement. However, to participate in the distribution of the $128 million for unpaid claims, you must file a claim for reimbursement [PDF] by Oct. 19. In filling out the claim form, note that Blue Cross and Blue Shield of Texas is included in the settlement under Health Care Service Corporation (HCSC). Payments for Blue Cross and Blue Shield of Texas count in the computations under Section C of the claim document.

In addition, compliance with many state statutes (including those that do not otherwise provide for a private right of action) that protect physicians also is enforceable through the enforcement provisions in the settlement. A compliance dispute resolution facilitator is available at no charge to a physician bringing a compliance dispute. In the other settlements, this process has proven very effective in promoting compliance with the settlement and recovering damages for physicians.

The Physicians Advocacy Institute, Inc. (PAI) also believes most physicians will find the Blue Cross settlement to be helpful and is examining ways to facilitate enforcement of the settlement for physicians electing to remain in the class. PAI was formed as a part of the Prudential settlement. It is composed of representatives of TMA and other state medical societies and representative physician plaintiffs involved in the suits against for-profit HMOs. The suits alleged the insurers conspired to defraud physicians. Texas, California, Connecticut, Georgia, Nebraska, New York, North Carolina, South Carolina, and Tennessee are all original signatories to the Blue Cross settlement, along with 12 other state medical associations, as well as additional signatory county and specialty societies.

You also have the option of donating your share of the settlement to the TMA Foundation, TMA's philanthropic arm that supports health improvement initiatives such as Be Wise — Immunize^SM and Hard Hats for Little Heads. Gifts to the TMA Foundation are tax deductible. Click here for more information.

Be Wise — Immunize is a registered service mark of the Texas Medical Association.

CIGNA Settlement Expires

CIGNA's agreement to settle its part of the lawsuits expired Sept. 4, ending its obligation to comply with the settlement terms. The expiration will not affect physicians who already have submitted valid claims for damages from the Claim Distribution Fund and are awaiting payment.

Physicians who have contracts with CIGNA should review their agreements and contact their provider representatives to determine how the expiration will affect their business relationships with the company. More information about the expiration is on the TMA Web site.

U.S. physicians have earned more than $500 million to date in cash payments to make up for past abuses in the settlements of our lawsuits against the country's biggest health insurers. Add in the value of the changes in the companies' business practices, and the value of the suits exceeds $2.5 billion.

Want to know more about the lawsuits against the HMOs? Click on www.texmed.org/rico or www.hmosettlements.com.

Action Main Page

Action is published 12 times a year by the Texas Medical Association.
401 W. 15th St.
Austin, TX 78701

(800) 880-1300

Editor: Larry BeSaw
(512) 370-1383

President:
William W. Hinchey, MD
Executive Vice
President:
Louis J. Goodman, PhD

Copyright 2007
by the Texas Medical
Association

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Since January 2003, Action, the TMA newsletter, has been distributed online only so that we can bring you more timely news and information.

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