Less than a year after Pomerantz Haudek announced a record-setting settlement with Health Net, Inc., valued by the Court at $249 million (including a $200 million settlement fund), it reports yet another settlement with United Healthcare Group which ups the ante once again. Pursuant to the settlement agreement, United Healthcare will create a $350 million settlement fund, from which insured members and their out-of-network providers will be entitled to make claims for reimbursement for United Healthcare's inadequate reimbursement levels. In addition, United Healthcare agreed in the settlement to enter into an Assurance of Discontinuance with the New York Attorney General, pursuant to which it would pay $50 million to fund the creation of a new and independent UCR database. The new database would replace the old databases promulgated by Ingenix, Inc., a wholly-owned subsidiary of United Healthcare, which are used by numerous insurers to set usual, customary and reasonable ("UCR") rates for out-of-network services. The Ingenix databases are alleged to be inherently flawed and unable to establish proper UCR rates.

"This settlement is truly historic," said Stanley M. Grossman of Pomerantz. "It not only establishes the largest settlement fund ever achieved in a private health care litigation, but, working through the Attorney General, it provides for resolving the entire Ingenix problem with the creation of a properly independent database."

The case was first filed in 2000 by the American Medical Association, the Medical Society of the State of New York and the Missouri State Medical Association, along with various individual subscribers and providers who had been adversely affected by United Healthcare's UCR practices. According to D. Brian Hufford, the Pomerantz partner primarily responsible for the litigation, "this settlement is the result of tremendous efforts over the last nine years to bring to light the Ingenix-UCR issue, and finally to achieve such a tremendous result is very satisfying." While the settlement still must be approved by the Court, Mr. Hufford adds that "we are confident that the Court will recognize how valuable the settlement is for the members of the class."

Note to Class Members: Once the court issues preliminary approval of the settlement, a class notice will go out which details what exactly needs to be filed by class members. It will take several months before any deadlines apply.

For questions or inquires regarding the settlement, please contact Robert J. Axelrod (rjaxelrod@pomlaw.com) at 888.476.6529 (or 888.4-POMLAW), toll free.

Click on the link below for article entitled Unions Seek Court OK in Health Insurance Case.

NYSUT Article

 



Back



Bookmark