Physicians and Groups with ‘Individually Negotiated’ Wellpoint Contracts Will Automatically Benefit from Prospective Relief
[Posted 09/08/05]

CMA and more than a dozen other state medical associations agreed in July to a settlement with Anthem/Wellpoint (Blue Cross of California), one of five remaining health plan defendants in CMA’s class-action RICO lawsuit. The agreement mandates dramatic changes in Anthem/Wellpoint’s heavy-handed business practices, which will result in prospective relief worth more than $250 million to physicians and their patients.

The original settlement agreement contained language that would have prevented physicians with “individually negotiated” contracts from benefiting from the settlement’s prospective relief, unless they send a letter to Wellpoint asking that their contracts be amended to include the court-ordered reforms. Wellpoint has agreed to update the settlement language so that physicians and physician groups with nonstandard contracts will automatically benefit from the settlement provisions, assuming the provisions are better than what they already have in their contracts.

The settlement also provides $135 million in cash payments to physicians. 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 based on the 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.

Physicians should have recently received information on the claim submission process from the settlement administrator. 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.

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