September 2006

Humana provides lawsuit settlement guidelines for DCs

As part of a recent $3.5 million settlement in the class action lawsuit Solomon, et al. v. Humana Inc., et al., Humana has released information regarding the recovery of individual provider claims for chiropractors and other non-MD providers.

Individual providers — referred to as class members — were mailed a notice explaining their rights under the settlement, as well as a claim form and claim form instructions. According to the settlement agreement, in order to recover claims, the class member must be a healthcare provider, provider group, or provider organization that provided covered services to a Humana member, or any person covered by a plan, between Jan. 1, 1990, and Aug. 16, 2006.

Humana will establish a fund of $3.5 million that will be divided pro rata among the class members that submit valid claims. The amount will be determined by the total dollar value of claims and the number of class members that have submitted claims. In order to obtain compensation, providers must submit a claim form with an estimate of the total billed charges, before the Jan. 13, 2007, deadline. As part of the settlement, doctors of chiropractic will be permitted to assign 100 or 50 percent of the recovery to the American Chiropractic Association (ACA), if they wish to do so.

In June, the ACA asked the U.S. District Court in Miami to allow ACA to join as a plaintiff in Solomon v. Anthem, et al., alleging that Humana and other managed care companies conspired to illegally and systematically underpay providers by denying reimbursement for medically necessary treatment. The $3.5 million settlement agreement was reached in early August. The case against the other defendants remains pending.

Source: American Chiropractic Association, www.acatoday.org

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