Anthem/Wellpoint Settlement Notices Will Be Mailed August 19
[Posted 08/18/05]

Physicians will soon receive material from the Anthem/Wellpoint settlement administrator, containing details of the settlement agreement and information on the claim submission process. Physicians have until November 17 (90 days from the date the settlement notices were mailed) to claim their share of the $135 million cash settlement.

Even if you did not treat Anthem/Wellpoint patients, you are still likely eligible for a pro rata share of the $135 million settlement fund. To be eligible, you need only have provided covered services to any patients covered by any of the defendants in this case—CIGNA, Aetna, Anthem, Coventry, Health Net, Humana, PacifiCare, Prudential, United Healthcare, and Wellpoint.

Physicians who did treat Anthem/Wellpoint patients will be paid from the $135 million settlement fund based on their total volume of Anthem/Wellpoint claims they submitted during a three-year period. Physicians with less than $5,000 in Anthem/Wellpoint claims will receive one share; those with $5,000 to $49,999 will receive five shares; and those with $50,000 or greater will receive 10 shares. The dollar amount of each share will be determined once all proof-of-claims have been submitted. Because Anthem/Wellpoint covers more than 6 million patients in California, many California physicians are expected to receive substantial settlement payments.

The agreement also mandates dramatic changes in Wellpoint/Anthem’s heavy-handed business practices, which will result in prospective relief worth more than $250 million to physicians and their patients. Among other points in the settlement, Wellpoint/Anthem has agreed to a patient-friendly definition of medical necessity and to cease using software programs that systematically lowball or deny payment for legitimate patient claims.

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