Tuesday, December 30, 2003

Humana to pay doctors more

Judges OK deal; other three cases pending

By Sharon Coolidge
The Cincinnati Enquirer

A Kentucky and an Ohio judge agreed Monday to allow a settlement between one of Greater Cincinnati's largest insurers and local doctors - a settlement that would increase reimbursement to doctors by $100 million over three years and create an oversight committee.

Humana Health Plans of Ohio, which estimates it paid doctors more than $270 million in 2003 for providing care, agreed to increase that amount by $20 million in 2004, $15 million on top of that ($35 million increase) in 2005 and $10 million more ($45 million increase) to the increases in 2006.

Then, from 2007 to 2010, a three-person oversight committee will monitor Humana's reimbursement by looking at random cases to make sure reimbursement rates are fair.

The case was brought by several doctor groups who accused four insurers - including Humana - of colluding for years to keep doctor payment rates unusually low in Greater Cincinnati.

The case is still pending against the other three insurers: Aetna Health Inc., United Healthcare of Ohio Inc. and Anthem Blue Cross & Blue Shield.

"Without question this is the only way problems of this nature can be solved in the community at large," said Hamilton County Common Pleas Judge David Davis, who sat with Boone County Circuit Judge Jay Bamberger in Kentucky on Monday. "It will serve not only the physicians, but those who are served by them."

"I've always felt doctors are the crown jewel of the community," said Stan Chesley, one of two attorneys who represented the more than 2,000 doctors who made the claim they were being underpaid by insurers.

Humana admitted no wrongdoing, saying they settled the case to avoid "long drawn-out litigation."

Russell Dean, executive director of the Academy of Medicine of Cincinnati, praised Humana for agreeing to settle. The academy and several other doctor groups filed lawsuits in 2002 in Hamilton County and Boone County courts alleging the collusion.

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.


E-mail scoolidge@enquirer.com

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