Aug. 12, 2004

As a result of the settlement between CIGNA and the nation’s physicians, tens of millions of dollars are currently available for retrospective relief – and physicians need not have had a contract with CIGNA to benefit monetarily. The AMA strongly urges physicians to submit claims for recovery specific to the settlement – the claims period begins Aug. 23 and concludes Feb. 18, 2005. All physicians should have received the settlement notice by mail in July. Physicians may choose only one of two funds from which to claim reimbursement:

1) The Category A settlement fund is open to all physicians, regardless of whether or not they submitted any claims to CIGNA, as long as they submitted claims to any of the other twelve managed care companies who are defendants in the suit. Each physician will receive a proportionate share of the $30 million fund in accordance with a payment formula in the settlement agreement.

2) The uncapped Claim Distribution Fund will compensate physicians affected by CIGNA's claim coding and bundling edits and/or medical necessity denials. There are three categories of compensation: one for specific CPT code combinations; one for all other combinations (physician specific edits); and one for claims denied as not medically necessary. Physicians can submit claims in all three categories of the Claim Distribution Fund. While physicians have a variety of options in recovering claims – including researching and submitting claims directly to the settlement administrator – the Managed Care Advisory Group (MCAG), a physician practice claims recovery company, now offers AMA members and select state and county medical society members considerable discounts on the recovery fees charged to physicians for its services. Click here to learn more about the CIGNA claims process.