By Tim Bonfield
The Cincinnati Enquirer

One of Greater Cincinnati's largest insurers agreed Thursday to increase reimbursement to local doctors by $100 million over three years to settle a lawsuit.

The Academy of Medicine of Cincinnati and several other doctor groups filed lawsuits in 2002 in Hamilton County and Boone County courts alleging that four insurers had colluded for years to keep doctor payment rates unusually low in Greater Cincinnati.

The deal takes Humana Health Plans of Ohio out of the cases without any admission of wrongdoing.

It does not affect the other three insurers - Aetna Health Inc., United Healthcare of Ohio Inc. and Anthem Blue Cross & Blue Shield.

The settlement has several implications for patients, employers, doctors and insurers.

About 4,000 doctors - more than 90 percent of all the region's doctors - do business with Humana. More than 400,000 Greater Cincinnati residents will be covered in 2004 by a Humana health plan.

Humana, which expects to pay doctors more than $270 million in 2003 for providing care, agreed to pay 30 percent more over three years.

Specific rate increases for doctors depend on negotiations between doctor groups and Humana. Not every doctor in town will see the same increase, if any, Humana officials said.

But doctors in 14 specialties that were recently identified as being in short supply in Greater Cincinnati would be among those most likely to get increases.

The specialties include anesthesiology, cardiology, general surgery, neurology, ophthalmology, lung disease, neurosurgery, thoracic surgery, orthopedic surgery and radiation oncology.

Russell Dean, executive director of the Academy of Medicine, praised Humana for agreeing to settle.

"To the degree that under-reimbursement was a part of why we were losing doctors in this community, this is a step in the right direction," Dean said. "We believe patients will be the winners in this because it will help stop the erosion of physician supply."

The settlement could mean patients will pay more for lower levels of health benefits. That depends on how much of the cost gets passed from Humana to employers and then to employees.

For most employers, rates they will pay for health benefits already are set for 2004.

Humana officials did not specify what increases employers might expect for 2005 and beyond.

The overall increase in payments is modest and predictable, said Larry Savage, president and CEO of Humana Health Plan of Ohio Inc.

"We continue to assert that there was no truth to the allegations in the lawsuit. There was no collusion," Savage said. "But this settlement is great news for the community because it allows a return to the sense of collaboration we need for the serious health care issues we face in our community and in our society as a whole."

Cincinnati attorney Stan Chesley, who represented doctors with attorney Rick Wayne, called it a landmark settlement.

"It brings a measure of dignity back to the medical community, which has been a crown jewel for this community. And this certainly sends a message to the other three defendants."

Anthem Blue Cross & Blue Shield has no intention of settling the case, said spokesman Joe Bobbey.

"We don't know why Humana decided to settle. We plan to continue defending against this lawsuit vigorously because we believe the case has no merit," Bobbey said.

Aetna and United officials could not be reached.

The proposed settlement must go through a hearing process, which could take several months. Before then, doctors will be allowed to accept the terms or opt out.

E-mail tbonfield@enquirer.com