Who is Eligible for this Settlement:
Any and All physicians, physician groups , or physician organizations who provided emergency services and care in Florida to any HMO plan members and who were paid by Aetna for those services outside of any contract or agreement during the class period. (June 3, 2003-December 15, 2008)
What is this settlement about:
The Class alleged that Aetna violated Sections 641.513 Florida Statutes, a statue governing “usual and customary” payments by Florida HMOs to physicians who rendered Emergency Services and Care to HMO plan members. For each claim you properly re-submit through the settlement process, you should receive the difference between 125% of Medicare Rates (Aetna’s historical allowance) and 238% of Medicare Rates (the agreed upon settlement amount)
How do you file:
You can choose to file on your own, or you may decide to enlist the assistance of an experienced third party to file on your behalf. The FOS has lined up a firm, Managed Care Advisory Group (MCAG), that is willing to assist our members in filing if necessary. To file on your own, you must submit a claim form to the settlement administrator by May 4, 2009. At this point, Aetna will use its “Best effort” to determine how much they underpaid your practice for the time frame of June 2, 2007 through December 15, 2008, and send you payment. If you choose to use MCAG (or another third party) to assist you in filing, you must complete the attached contract and submit it to MCAG no later than April 27, 2009. At this point, a MCAG representative will contact you to gather the information necessary to file a claim. MCAG will use the billing information (Provided by you, or your billing company) to audit Aetna’s “Best Effort” calculation, and perform the necessary appeals to ensure that you receive what is rightfully yours. MCAG will also use the billing data to determine if you are eligible to submit claims that were underpaid before June 2, 2007. To do so, the settlement requires the class member to submit supporting documentation, which MCAG will recreate from the billing data when possible, and work with your practice to retrieve other documents if necessary.
Click below to view the settlement agreement. The agreement will give you more details and information on how to file on your own.
Assistance with filing?
If you decide you would like assistance to ensure you receive the appropriate compensation from the settlement, the FOS is teaming up with Managed Care Advisory Group (MCAG) to assist physicians in filing.
Who is Managed Care Advisory Group:
Managed Care Advisory Group (MCAG) is a company that has been very successful working with AMA and many other State, Local and Specialty Medical Societies to help physicians collect the maximum amount they were due under the MDL HMO Class action Settlements. MCAG was able to help over 90,000 physicians across the country collect more than $150 million under these class action settlements.
If you have any questions, please contact MCAG at (800) 355-0466.
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