The ISMA is reminding physicians that protections of the WellPoint/Anthem national multidistrict litigation (MDL) class action settlement agreement are set to end July 15. After that date, Wellpoint/Anthem no longer will have to comply with the settlement terms.

Physicians who are contracted with WellPoint/Anthem are encouraged to review their contract to determine how the settlement expiration will affect their business relationship with the health insurer. Anthem will still have to comply with state law, but the settlement agreement is more expansive in some ways and in some instances, also applies to ERISA claims, which are sometimes exempt from state laws, explained Julie Reed, ISMA legal counsel.

Outstanding claims as a result of the Anthem computer transition problems also would come under the settlement agreement. Terms of the settlement require that the company’s internal dispute process be exhausted before complaints can be submitted to the settlement agreement compliance dispute process.

“Compliance disputes are a way for physician practices to obtain relief for improper claims processing and payment. They are not difficult to file. Practices have filed complaints over various settlement violations and have been made whole through the process,” said Cam Staples, compliance dispute facilitator for the settlement agreement.

“Practices need to take the first step of filing compliance disputes soon because the second step, the arbitration process, has to begin before the July 15 deadline,” he added.

Learn more from the AMA and HMO settlement Websites:

• Download a check list (PDF) of key settlement terms here.
• Find the complete settlement agreement (PDF) here.
• Access information about MDL settlements as well as settlements with other health insurers here and here.