Friday, April 25, 2008

Highmark settles suit

http://www.bizjournals.com/pittsburgh/stories/2008/01/07/story1.html?b=1199682000%5E1571338

Highmark Inc. will pay $9.9 million and change the way it does business with doctors, including how appeals are handled, to settle a class action lawsuit that was filed in 2003 against Blue Cross Blue Shield plans nationwide, according to terms of a preliminary agreement.

"The news is the reforms Highmark has agreed to adopt," said attorney William Maruca, who practices with the Downtown offices of Fox Rothschild LLC and represents the Allegheny County Medical Society. "The major impact will be in improving the way Highmark deals with physicians."
Among the terms of the proposed settlement is disclosure of fee schedules to participating physicians; expanded arbitration provisions for claim disputes; an end to recovering overpayments after 18 months except in cases of fraud; and establishment of a 12-person physician advisory committee to consult with the insurer on a variety of matters, such as clinical quality improvements. The tentative agreement also requires a committee of physician peers to evaluate medical necessity issues and an external review panel to mediate appeals of insurance claims that have been denied.
"Payments vary sometimes, and it's hard to tell why," Maruca said.

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