RICO Settlement Checks Have Caused Confusion
[Posted 03/17/05]

The Aetna settlement checks and the CIGNA settlement Claim Distribution Fund checks have begun to be received by physicians. Because the CIGNA claim period just ended, some physicians receiving Aetna settlement checks are mistakenly assuming that they are CIGNA checks. As the CIGNA checks will in most cases be much larger than the Aetna checks, this confusion has understandably upset some physicians. Physicians and their office staff should pay close attention to the cover letter enclosed with each check, as the letter specifies from which settlement the payment is being issued. The Aetna checks will come addressed from “Aetna Managed Care Litigation” and the CIGNA checks will come from “CIGNA Physician Settlement.”

The very modest Aetna checks are a token gesture for past grievances. The real value of the Aetna settlement lies in the prospective relief. The goal of CMA’s lawsuit was to change the practices of for-profit HMOs and make managed care fair and transparent for physicians and patients. The settlement accomplished this goal going forward by, among other things, requiring Aetna to comply with most of AMA’s CPT coding guidelines, apply a clinically based definition of medical necessity, and have its billing determinations reviewed by independent experts. Experts estimate the future value of the Aetna settlement at more than $300 million.

Physicians who submitted Aetna proof-of-claim forms by the September 2003 deadline will receive settlement checks. The majority of class members did not file proof-of-claim forms, and their portion of the settlement money was automatically donated to the Physicians’ Foundation for Health Systems Excellence. This foundation, created as part of the settlement agreement, will promote physician-directed improvements to patient safety and quality of care.

CIGNA claims submitted for payment to the Claim Distribution Fund (CDF) are also being paid out now. The settlement administrator is required to validate each CDF claim within 30 business days of receipt. Once validated, CDF claims must be paid within 14 calendar days. The pro-rata CIGNA Category A claims will be paid once the settlement administrator has finalized that portion of the settlement.

CIGNA is also required under the settlement to make significant changes in the way it works with physicians, providing more than $400 million in prospective relief.

For more information on the Aetna settlement (including instructions on how to appeal your payment) contact:

Aetna Managed Care Litigation
Settlement Administrator
PO Box 3656
Portland, OR 97208-3656
877/202-8864

For more information on the CIGNA settlement (including instructions on how to appeal your payment) contact:

CIGNA Physician Settlement
Settlement Administrator
P.O. Box 3170
Portland, OR 97208-3170
877/683-9363

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.