Step-by-Step Compliance Dispute Procedure (Draft Pending Final Appeals)
Listed below are the steps to take to challenge a violation of the terms of Section 7 of the Settlement Agreement. Section 7 lists the business practice changes to which Health Net has committed.
Any physician who has not opted out of the Settlement may file a compliance dispute with the Compliance Dispute Facilitator (the "Facilitator"), Cameron C. Staples. Compliance disputes must be filed within 90 calendar days of the date the dispute arose or was reasonably discovered.
Signatory Medical Societies are able to assist physicians from any state on these settlements, and will file on their behalf. "Additional signatory medical societies" may also assist in some settlement agreements. For a list of these societies, see www.hmosettlements.com
The form must be completed by the physician or his or her office staff, and must include the physician's signature. The physician should describe, using specific facts, the health plan's conduct which he or she believes constitutes a material breach of the health plan's obligation under Section 7 of the Agreement. The physician should also specify which provision of Section 7 has been breached, and describe how he or she has been harmed by the breach.
- The physician should attach to the form any supporting documentation, including any correspondence between the physician and the health plan, and any records which the physician believes are relevant for the Facilitator to determine the merits of the complaint.
The completed form and attachments should be mailed to the Compliance Dispute Facilitator at the address below. No fee is required.
After the Facilitator receives the compliance dispute form, the Facilitator will contact the physician to advise whether the form is properly completed, and whether, in the Facilitator's opinion, the alleged wrongful conduct is a compliance dispute.
- The Facilitator will prosecute the dispute on the physician's behalf without charge, and keep the physician informed as the compliance dispute process takes its course.
The address for the Facilitator is:
Cameron C. Staples
Neubert Pepe & Monteith, PC
195 Church Street
New Haven, CT 06510
Telephone: (203) 821-2000