PA Blue plan pays $9.9M to settle physician suit

Physicians working with Pennsylvania Blue plan Highmark Inc. are in the final stages of a settlement [1] which will compensate them for times when the health plan allegedly shortchanged them on reimbursement. The suit, part of a larger action which included more than 90 percent of Blue Cross plans and other big insurers, will compensate roughly 900,000 physicians. The doctors asserted that Highmark underpaid them for services delivered from 1999 through 2007. Highmark and the plaintiffs reached an agreement in November. Doctors now have until January 14th to either object to the settlement or opt out. They have until February 27 to file a claim.

While the money is welcome, doctors say that they're equally pleased by operational changes Highmark has agreed to make. Under the terms of the agreement, the plan will now disclose fee schedules to participating physicians, expand arbitration options for claims disputes, waive recovery of overpayments after 18 months unless fraud is involved, and consult with physicians on key issues--notably clinical quality improvements.

To find out more about the settlement:
- read this Pittsburgh Business Times piece [2]

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