Notes on the HMO settlement

The recent settlement of the lawsuits against Aetna, CIGNA, Health Net Inc., Prudential Insurance Company of America, Anthem/WellPoint, and Humana Inc is now in the implementation stage. A new website has been set up with information and alerts concerning the settlement and implementation. The AMA website contains good background as well for those who haven't been following things closely. In a recent E-news, the AMA stated: "Physicians are urged to stay vigilant in reviewing claim payments from these health plans to ensure they are adhering to the settlement terms. In doing so, physicians and their practice staffs should audit and track all payments from these health plans to make sure they process and pay claims according to the settlement agreements. Physicians are encouraged to file a claim appeal with a health plan that does not adhere to its settlement provisions and record a compliance dispute if necessary." Remember the movie "Network" when one of the lead characters opens a window and shouts, "I'm mad as hell and I'm not going to take it anymore!" ? For so many years, so many physicians would roll over and sign any contract put before them. No questions, no attempt at negotiation, nothing. Worse, many didn't read or didn't understand the contract. I heard from many a practice manager who would be tearing their hair out when their physician bosses fif this, and then took it out on the manager when the payments came through. So, just to repeat age old advice: never sign something you haven't read or if you don't understand. There are no offers that are "good today only" - never sign under duress. You can suggest to the person trying this manuver that contracts signed under duress may lose some credibility and legal standing (call their bluff - what the heck). Always run the numbers - while you may make less of a profit under a contract, profit is profit. Score one for the good guys.