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Class action lawsuit alleges CIGNA alters cases to reduce payments

Physicians, medical societies and lawyers who hammered out agreements with Aetna and CIGNA that will change the way the health plan giants handle physician claims have no reason to believe the changes won't go as promised.

But they aren't taking any chances. The claims period began August 23, 2004 and concluded on February 18, 2005. Financial terms of the settlement were not disclosed.

The 40 medical societies that signed on to each agreement will help in making sure that the companies follow the settlement agreements and change their business practices.

"It's one of those trust-but-verify situations," said Connecticut State Medical Society Executive Director Timothy B. Norbeck. CSMS is one of the original medical societies to sue Aetna and CIGNA over the way they paid physicians. The Medical Assn. of Georgia, Texas Medical Assn., California Medical Assn. and more than a dozen other medical societies also were part of the original lawsuits.

But lawyers and organized medicine leaders said grassroots physicians also need to be alert for problems and report them so that the agreements are more than words on paper. The settlements cover an estimated 900,000 active and retired doctors.

Two physicians are the lead plaintiffs in the class action lawsuit filed against CIGNA Corp. alleging the health insurer alters medical claims in order to pay physicians less.

900,000

doctors could

be involved in CIGNA class-action lawsuit.

Dr. Timothy N. Kaiser of Illinois and Dr. Suzanne LeBel Corrigan of Texas are the primary plaintiffs in the case that names CIGNA HealthCare of St. Louis and CIGNA HealthCare of Texas as defendants. The suit accuses CIGNA of "cryptic and confusing" business practices.

Specifically, both doctors charged CIGNA with "downcoding" and "bundling" treatment claims. Downcoding means less expensive services are paid for on a claim for more expensive services rendered. Bundling is the

practice of lumping several services provided together and paying for only one, treating all the services as one unit.

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