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American Chiropractic Association

FOR IMMEDIATE RELEASE

Humana Provides Lawsuit Settlement Guidelines for Chiropractors, Non-MD Providers
(Arlington, Va. - Sept. 21, 2006) As part of a recent $3.5 million settlement in the class action lawsuit Solomon, et al. v. Humana Inc., et al., Humana has released information regarding the recovery of individual provider claims for chiropractors and other non-MD providers.

Individual providers—referred to as class members— were mailed a notice explaining their rights under the settlement, as well as a claim form and claim form instructions. According to the settlement agreement, in order to recover claims, the class member must be a health care provider, provider group or provider organization that provided covered services to a Humana member, or any person covered by a plan, between Jan. 1, 1990, and Aug. 16, 2006.

Humana will establish a fund of $3.5 million that will be divided pro rata among the class members that submit valid claims. The amount will be determined by the total dollar value of claims and the number of class members that have submitted claims. In order to obtain compensation, providers must submit a claim form with an estimate of the total billed charges, before the Jan. 13, 2007, deadline. As part of the settlement, doctors of chiropractic will be permitted to assign 100 or 50 percent of the recovery to the American Chiropractic Association (ACA), if they wish to do so.

In June, the ACA asked the U.S. District Court in Miami to allow ACA to join as a plaintiff in Solomon v. Anthem, et al., alleging that Humana and other managed care companies conspired to illegally and systematically underpay providers by denying reimbursement for medically necessary treatment. The $3.5 million settlement agreement was reached in early August. The case against the other defendants remains pending.

In addition to the cash fund described above, terms of the proposed settlement agreement with Humana include: Changes in Humana’s business practices, intended to make its claims editing process more transparent and reduce confusion and disagreement over payments.

Online information provided by Humana to help providers understand its payment decisions . More options for chiropractors and other health care providers to challenge Humana payment decisions in the future, if necessary. Independent external reviews to resolve billing disputes. The appointment of an ACA representative to a newly formed Humana health care provider advisory committee, which will provide a means of direct communication on issues and concerns.

For a copy of the settlement agreement, click here. For more information on submitting a claim, visit the Humana Provider Settlement Web page or ACA’s Chiropractic Networks Action Center. For related questions, e-mail insinfo@acatoday.org, or call ACA’s Insurance Relations Department at (703) 276-8800.