From the Field

October 5, 2010 is deadline to file claims in the United Healthcare Ingenix settlement

United Healthcare Corp. has settled in federal court and psychologists are part of the nationwide provider class eligible to submit claims to the $350 million settlement fund

By Legal and Regulatory Affairs Staff

April 28, 2010 — A number of psychologists have just received a 15-page Notice of Proposed Settlement of Class Action and Final Settlement Hearing in the case against United Healthcare Corp. in the U.S. District Court for the Southern District of New York. This class action by subscribers and providers alleged that United used the flawed database of its subsidiary Ingenix to reduce the "usual, customary and reasonable" (UCR) rates on which the company based reimbursement for out-of-network services.

The settlement notice is available online

Psychologists are part of the nationwide provider class that is eligible to submit claims to the $350 million settlement fund that will be shared with subscribers. October 5, 2010 is the deadline for submitting claims

The APA Practice Organization (APAPO) will provide detailed guidance about eligibility and how to submit a claim well in advance of the October deadline.

The claim provisions are complicated, but basic requirements for submitting a claim include:

  • You provided covered out-of-network services to United subscribers between March 1994 and November 2009.

  • You received an assignment from a United subscriber and submitted a claim under that assignment.

United will be providing the settlement administrator with claims information going back to January 1, 2002. You can submit a claim based solely on that information. However, greater settlement amounts may be available if you can document claims before that time and/or provide additional documentation -- for example demonstrating that you billed a patient for amounts not reimbursed by United and that bill was not paid.

Brief history  

United agreed to this settlement in early 2009, but the settlement was contested by some class action counsel who argued that the amount was too low.  Thus, the court did not grant preliminary approval to the settlement until last November. The settlement will not be finalized until the court approves it after a final fairness hearing now scheduled for September 13, 2010.

The APA Practice Organization is collaborating with the New Jersey Psychological Association (NJPA) and California Psychological Association (CPA)on ongoing nationwide class actions alleging that CIGNA, Aetna and WellPoint also used United’s Ingenix database to reduce UCR payments for out-of-network services. The APA Practice Organization is working closely with the state psychological associations that are plaintiffs in those cases, and with outside counsel to provide extensive legal, policy, communications and other support for those legal actions.

These cases with NJPA and CPA continue APAPO’s involvement in class action cases targeting harmful managed care practices, starting in 2004 with the class action lawsuits in Florida federal court that resulted in settlements with CIGNA and Humana totaling $15 million. In that litigation, APAPO collaborated with the Florida Psychological Association.

PLEASE NOTE: Legal issues are complex and highly fact-specific and require legal expertise that cannot be provided by any single article. The information in this article should not be used as a substitute for obtaining personal legal advice and consultation prior to making decisions regarding individual circumstances.