CIGNA Settlement Information

The following documents will help you understand your rights under the CIGNA settlement agreement.

Pertinent information:

Questions about the settlement may be directed to Whatley Drake& Kallas, L.L.C., at (866) 809-8003.

Compliance dispute facilitator (CDF)
Physicians may consider filing a “compliance dispute” if prohibited clauses are contained in a health plan’s contract or if the health plan fails to adhere to the terms of its settlement.  After the dispute is deemed valid by the CDF, the CDF will act as the physician’s representative unless the physician or Signatory Medical Society, acting on the physician’s behalf, elects to employ separate counsel.  Below is the contact information for the CIGNA CDF:

Deborah J. Winegard
c/o Doffermyre Shields Canfield Knowles and Devine
1355 Peachtree St., Suite 1600
Atlanta, GA 30309
Phone: (404) 881-8900
Fax(404) 881-3007

To learn more about foundations created by the settlements, please go to the Physicians Foundation Web site.

How the CIGNA settlement agreement helps the physician practice flyer (prepared by AMA) contains a summary of the key business practices mandated in the CIGNA Settlement. Since contracts provided by CIGNA to physicians in its provider network must conform to the Settlement, physicians are encouraged to review their contracts to ensure they are receiving available protections.

A Web site was established in connection with this settlement among CIGNA HealthCare, physicians and certain medical societies in the Managed Care Litigation that is pending in the U.S. District Court for the Southern District of Florida.

For CIGNA dispute procedures, click on the links below:

• CIGNA Compliance Dispute Procedure
• CIGNA Settlement Claim Distribution Fund Procedure (Retrospective Relief)
• CIGNA Category A Settlement Fund

For CIGNA Claim Forms, click on the links below:

• CIGNA Filing Instructions
• CIGNA Compliance Dispute Claim Form
• Category A Proof of Claim Form
• Category One Compensation Proof of Claim Form
• Category Two Compensation Proof of Claim Form

CIGNA Category One Code List

CIGNA Healthcare, Inc., and physicians negotiated a list of specific CPT code combinations that qualified for Category One Compensation as part of the class action settlement. Upon submission of valid proofs of claim, members of the class received the specified reimbursement identified for denial of payment for Category One Codes in the specific circumstances and within the date of service limitations set forth in the list.

CIGNA Category One Code List.

2002 Medicare Part B CPT Data Summary

A spreadsheet, the 2002 Medicare Part B CPT Data Summary, was prepared by the AMA, and was used as a guide by physicians to better determine if their practice may have billed for certain procedures and services identified in the CIGNA Category One Code List. Please refer to the CIGNA settlement agreement for a description of the information appearing in the Category One Code List.

The Current Procedural Terminology (CPT) code utilization and physician specialty frequency information summarized in the spreadsheet was derived from aggregate information on utilization for physician services covered by Medicare Part B during the calendar year 2002. No fee schedules, basic units, relative values, or related listings were included in CPT.

The spreadsheet data was taken from CMS's 2002 Physician/Supplier Procedure Summary Master File (PSPSMF) which "... represents procedure-specific billing data for all (i.e., 100 percent) physician/supplier services rendered to all Medicare beneficiaries during calendar year 2002 and processed by the carriers through June 30, 2003." Only Part B services processed by carriers were included. The AMA does not warrant the accuracy of this data.

2002 Medicare Part B CPT Data Summary

Current Procedural Terminology (CPT^®) is copyrighted by the American Medical Association.

This summary has been prepared by the American Medical Association (AMA) Private Sector Advocacy unit from information provided to the AMA.

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