The insurance company was sued before the statute of limitations ended. Motion after motion is filed delaying a trial. After losing motion after motion, the insurance company decides to settle. The settlement offer sets the dates of service which the insurance company or court will decide will fit within the settlement, These dates can go back many many years. They do this knowing the doctor has no records that far back.
Doctor A keeps excellent records. Dr B doesnt. Dr A can go back to the beginning of the settlement date with the records. Dr B cannot. Dr A sends his data in. He is eventually paid. Dr B doesnt send his claim or it is late as he spends time trying to find the data. The insurance company keeps the money not paid to Dr B.
The following is from the Healthnet Class Action lawsuit from the Berden Claims website:
http://www.berdonclaims.com/cases/Details.aspx?cid=187#tb_mainYou qualify for participation in the Settlement if at least one of the following applies:
- You are, or were, from April 1, 1997 to August 31, 2004, a subscriber or beneficiary in any large or small employer plan, other than in a New Jersey small employer plan, who received medical services or supplies (including, inter alia, surgery, anesthesia, and the like) from an out-of-network provider and for whom Health Net made reimbursement determinations less than the providers’ actual charge (The McCoy Class);
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You are, or were, from July 1, 1995 to August 31, 2004, a subscriber or beneficiary of any New Jersey small employer plan, who received medical services from an out-of-network provider and for whom Health Net made reimbursement determinations less than the providers’ actual charge (The Wachtel Class);
- You are, or were, from September 1, 2004 through July 31, 2007, a member in any large or small employer plan insured by Health Net, and subject to ERISA, who received medical services or supplies (including, inter alia, surgery, anesthesia, and the like) from an out-of-network provider and received reimbursement of less than the provider’s billed charge (The Scharfman ERISA Class); or
- You are, or were, from September 1, 2004 through July 31, 2007, a member in any large or small employer plan, or any individual and family plan, insured by Health Net, who received medical services or supplies (including, inter alia, surgery, anesthesia, and the like) from an out-of-network provider and received reimbursement of less than the provider’s billed charge that was determined by Health Net, Guardian or a third party vendor applying Health Net’s out-of-network claims practices, including the use of Ingenix data (The Scharfman RICO Class).
1995 was 16 years ago. How many out of network providers have records that far back?
Even still 2004 was 7 years ago.
