• Presentation: HORIZON: Class-Action Compliance—How to File a Dispute
• Horizon’s Letter Dated February 2010 Announcing New Payment Policies on Modifiers
• MSNJ’s Compliance Dispute Against Horizon Concerning Modifiers 25 & 59
• Horizon’s Letter Dated March 18 Revising Payment Policy on Modifier 25
• Horizon’s Letter Dated May 14 Revising Payment Policy on Modifier 59
• 4/15/10 HORIZON: Overpayment Requests Violate Settlement Agreement & NJ Law

          In mid-April 2010, the national class-action settlement administrator for the UnitedHealth Group UCR settlement began mailing notices to physicians who provided out-of-network services to its members. If you rendered these services and did not receive this notice, MSNJ urges you to contact the settlement administrator and/or to download the notice for details.
         This national class-action lawsuit was filed by the American Medical Association and the New York and Missouri Medical Societies a decade ago.  It alleged a price-fixing scheme used by UnitedHealth Group and other insurers to underpay physicians and patients for out-of-network care through use of the downward skewed Ingenix database of fees. Ingenix is a UnitedHealth Group subsidiary.
          The New York Attorney General (NYAG), Andrew Cuomo, first reached a settlement with United Healthgroup in which it agreed to pay $50 million toward the establishment of a new, independent database to be used by health insurers to determine rates for out-of-network fees. Ingenix agreed to give up the UCR database. The day after the NYAG settlement agreement, the national class-action was settled for $350 million.  
          Physicians who provided covered out-of-network services between March 15, 1994 and November 18, 2009, to patients covered by a health plan insured or administered by the defendants, UnitedHealthcare, Oxford Health Plans, Metropolitan Life Insurance Company, and others, are members of the class. In addition, physicians who billed one of the defendants during this time period through an assignment of benefits (checking “yes” on box 13 of the HCFA/CMS 1500 form) are members of the class. Class members are eligible to file a claim for a portion of the $350 million settlement fund.  All physicians, regardless of class membership, will benefit from an independent database used to establish out-of-network fees.

     The following are court-imposed deadlines that physicians must follow:

1. July 27, 2010—Deadline for filing objections to the settlement or for opting-out of the settlement;
2. September 13, 2010—Date for the final settlement hearing to consider any filed objections; and
3. October 5, 2010—Deadline for filing a claim to share in the settlement fund.

          Read the Frequently Asked Questions for details on this settlement agreement. Read the Step-by-Step Guide to maximize your recovery under the settlement agreement.

          Plan to attend a seminar on How to File a Claim to receive your fair share of the settlement fund on June 22 at MSNJ.  

          Visit the AMA’s web site for on-line resources.