Members Can Gain From United Health Group Settlement
Have you served in the last 15 years as an out-of-network physician for patients with United Health Group insurance? If so, then you may benefit from United’s recent settlements of a state investigation into its out-of-network reimbursement practices. The two settlements with the New York State Office of the Attorney General resolved a dispute on United's use of a flawed payment database that one of its subsidiaries, Ingenix, operated. United used the database in calculating reimbursement to out-of-network physicians. Under the first settlement, United agreed to stop using the database. It also agreed to pay $50 million toward a new, independent database that health insurers can employ to set out-of-network rates. The improved database should help all radiologists and radiation oncologists receive fairer reimbursement.
Notably, United agreed in the second settlement to pay $350 million toward settling claims brought by health plans, out-of-network physicians, and health care providers who alleged they received inadequate reimbursement because of the flawed database. You may be eligible to submit a claim for reimbursement if you provided covered out-of-network services to patients insured by United Healthcare, Oxford Health Plans, Met Life Insurance, American Airlines or their affiliates between March 1994 and November 2009; and billed one of these plans under an assignment from the patient. You must submit a claim by Oct. 5, 2010.
The American Medical Association has established a resource center on the United settlements with FAQs and answers, with a guide to making a claim for payment: http://bit.ly/aCM8RA.
ACR soon will post on its website a flyer co-branded with AMA that offers detailed settlement information.
