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Settlement agreement ended September 4!

The Physicians Advocacy Institute is trying to persuade CIGNA to continue to abide by the terms.

CIGNA will still provide fee schedules, pay reasonable fees for vaccines (?!), and not downcode E&M

CIGNA could reinstate all products clause, could change the fee schcedule more frequently, reinstate silent PPOs, and recoup further back.

Suggestion: negotiate for the settlement terms that impact your practice

Health Net

Coding rules

Copies of contracts (with attachments!!) will be provided within 30 days or as soon as practical.

Health Net shall provide its formulas or database used to construct fee schedules

Healthnet will respond wtihin 10 days to e-mailed inquiries requesting ffs dollar amount allowable for those codes that specialty reaaonably uses up to twice a year.

Physicians can opt out of products.

Claims must be processed within 30 days, 15 for electronic.

There will be no retroactive retraction of a pre-certified medically necessary determination.

Credentialing applications can be submitted prior to new employment and will be processed within 90 days.

Monthly Medical-Legal Roundtable – The Managed Care Settlements, September 2007 Presented by Heather Skelton, Attorney at Law



  • Starting this week, claims must be paid within 15 days. Interest will be 6% per year.

  • Retro recoupment is limited to 18 months.

  • See coding rules

  • No retro retraction of a pre-certified medically necessary determination

Remedies: File a compliance dispute – it is free!

More Info:


h t t p : / / w w w . n c m e d s o c . o r g / m e m b e r s / p a g e s / p a y o r _ i s s u e s / h m o _ l a w s u i t s . h t m l

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©2007 Heather Cook Skelton, Attorney www.doctorslawyer.com

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