The checks are in the mail

Members report receiving monies from the Ingenix settlement by United HealthCare

By Legal and Regulatory Affairs staff

March 8, 2012—In early 2009, United HealthCare entered into a $350 million settlement, a record settlement by a health insurer. The company settled claims by a nationwide class of subscribers and providers, including psychologists, that the company had used its flawed Ingenix database to improperly reduce “usual, customary and reasonable” (UCR) reimbursement for out-of-network services. The federal court in New York set October 5, 2010 as the deadline for providers and subscribers to submit claims to the settlement fund.

The APA Practice Organization advised members of the settlement deadline and helped them determine if they were eligible to receive payment from the settlement. We provided detailed instructions to help members navigate the complex process for submitting claims set forth in the fine print of the 15-page settlement notice.

On February 3, 2012, the court approved the proposed distribution of settlement funds by the settlement administrator, Berdon Claims, under the complicated allocation formula. The court’s order allowed Berdon to move forward with issuing checks to settlement claimants.

Initial reports indicated that the checks would be issued by April. In late February, however, the APA Practice Organization first learned of a psychologist receiving a settlement check. Those psychologists who submitted valid claims by the October 2010 deadline should check their mail for window envelopes containing checks that state:

United HealthCare Class Action Litigation Settlement Fund
C/O Berdon Claims Administration LLC

Predicting the amount of any particular psychologist’s settlement check is not possible because it depends on the total volume of claims submitted by subscribers and providers nationwide as well as individual factors, including the dollar amount of out-of-network services for which a settlement claim was submitted and the level of documentation and other proof provided to support the claims. 

According to the American Medical Association, the settlement fund to be paid to claimants was almost $200 million. The remainder of the $350 million total settlement is accounted for in part by considerable funding to develop a new, fairer database for valuing out-of-network claims (to replace the flawed Ingenix database), as well as attorneys’ fees and claim administration costs.

The Ingenix class action against United was only one of several Ingenix lawsuits. The Practice Organization continues to collaborate with the California and New Jersey psychological associations on nationwide class actions against the WellPoint/Anthem BCBS companies, Aetna, CIGNA and Horizon BCBS.

After considering defendants’ motions to dismiss the lawsuit, the federal judge hearing the California case against the WellPoint/Anthem BCBS companies has allowed key legal claims to move forward. However, the federal judge in the CIGNA case has dismissed the providers’ claims. Our attorneys are developing strategies in response to that ruling.

We will keep members apprised of major developments in these cases.

For more information, contact the Legal and Regulatory Affairs department by email or by phone at (202) 336-5886.