pull from, and the amount each physi- cian gets depends on how many people file claims. But the nice thing is the money they recoup goes to the practice’s bottom line. Physicians appreciate the money,” Mr. Schmidt said. MCAG receives a flat percentage — typically 20 percent to 30 percent — of what the company actually collects in cash on behalf of the physician. For guidance and information on sub- mitting claims in the Aetna settlement, visit the Whatley Kallas, LLC, website,
www.whatleykallas.com. For more in- formation on MCAG services, visit www
.mcaginc.com.
Physicians benefit from settlements
The way insurance companies conduct business has long been subject to scru- tiny by organized medicine. Physicians nationwide have received $2 billion in benefits from settlements with defen- dants in the Racketeer Influenced and Corrupt Organizations Act (RICO) cases, including the majority of Blue Cross and Blue Shield plans, Aetna, CIGNA, Health Net, Prudential Insurance Company of America, Anthem/WellPoint, and Hu- mana. The class action lawsuits filed in 2001 against large for-profit HMOs in- clude approximately 900,000 physician plaintiffs. TMA was one of the first medi- cal societies to join the suit. As a result of the settlements, the in- surance companies agreed to make key changes to their business practices and restructure the way they administer and pay for medical care. Bohn Allen, MD, TMA past president, was part of the team that negotiated the settlements in the RICO cases. For five years, he served as a member of CIGNA’s Physician Advisory Committee, a group charged with holding the company ac- countable to the terms of the settlement. He counts among the committee’s victo- ries its assistance in resolving a dispute over the company’s failure to recognize some codes amended with modifiers 25 and 57. CIGNA subsequently began recognizing the Medicare modifiers and agreed to explain on its website when it would not reimburse for services ap- pended with those modifiers.
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