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What We Are Up To NowImproper Insurance Company PracticesInsurance companies practices can result in the failure to pay legitimate bills due for medical services. Typically when an insured patient obtains medical services, they assign the rights to be reimbursed by their insurance company over to the healthcare provider who, in turn, submits the bill to the insurance company for payment. When insurance companies improperly reject some or all of those bills, it creates havoc for both the healthcare provider and the patient. The patient remains responsible to the healthcare provider and the healthcare provider incurs additional costs in an effort to collect what is due. The firm is working with other firms on three major cases directed at this practice. One of them is In Re: Managed Care Litigation; Shane, et al. v. Aetna Inc., Cigna Corp., et al. pending in federal court in Miami. On behalf of 700,000 physicians we are contending that the defendant insurance companies conspired to cheat the doctors out of billions of dollars by denying or manipulating claims to wrongly reduce or delay payment. To date, a settlement has been reached with Aetna and Cigna. Both companies have agreed to change their practices and to pay the physicians back for the losses. Aetna has agreed to pay approximately $470,000,000 and Cigna has agreed to pay between $500,000,000 - $700,000,000 depending on the implementation of changes in how they do business. We are pleased to report that a very important victory was just achieved in the case that continues to be pursued against Humana, UnitedHealthcare, PacificCare, Prudential and Wellpoint. In a 70 page opinion, the 11 th Circuit Court of Appeals has ruled that the trial court’s order certifying the case as a class action for the benefit of the doctors was correct and the case can continue to proceed as a class action lawsuit on the racketeering and criminal conspiracy claims that have been asserted. The insurance companies’ challenge to that part of the case was denied. The victory was described as “huge” by one of our co-counsel and the 600,000 doctors who we represent will now proceed towards a settlement or trial. We are pleased to report that all of the legal work on this critically important issue was handled by Jim Tilghman of our office. Jim presented the matter to the trial court, wrote the appellate brief and argued the case on behalf of the doctors during the oral argument before the 11 th Circuit Court of Appeals. Please click below for a link to a recent newspaper article regarding this. |
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