Physicians should be aware that the CIGNA settlement agreement expired on September 4 and the insurer no longer has to comply with the settlement terms. Physicians are encouraged to review their CIGNA contracts and contact their provider representatives to determine how termination of the settlement will affect their business relationships.

As you know, CIGNA in 2003 became the second health plan to settle the civil racketeering lawsuit initially filed by CMA in 2000. As part of the settlement, CIGNA made a four-year commitment to change the way they do business with physicians and to put a stop to business practices that were used to deny or delay payment to physicians for legitimate claims.

CIGNA has said that it would voluntarily continue the settlement's prohibition on downcoding E&M codes, follow the settlement's coding rules, and continue to pay appropriate rates for vaccines. The Physicians Advocacy Institute, including representatives from CMA, has been working with CIGNA, encouraging them to voluntarily continue most of the business practices required by the settlement in an effort to foster continued communication with physicians and transparency of the payment process. Based on these discussions, CIGNA has agreed, among other things, not to seek recovery of alleged overpayments more than twelve months old.

However, physicians must continue to be diligent in reviewing their CIGNA contracts. Some physician contracts recently distributed by CIGNA contain provisions that don't live up to their stated commitments.

For more information:

• Impact of Termination of CIGNA Settlement
• CIGNA Settlement Agreement to End September 4: Review Your Contracts! (from AMA)

Contact: Aileen E. Wetzel, 888/401-8911 or awetzel@cmanet.org.