Judge Federico A. Moreno of the United States Federal Court for the
Southern District of Florida has issued an additional Order in the physicians
lawsuit against the abusive practices of HMOs. The Order requires Defendant
Anthem to respond to the Plaintiff’s Motion to Amend the Complaint by August 16,
2002 with a response due by Plaintiff’s no later that August 30, 2002. The
Defendant’s must file motions relative to arbitration by the 16th as well. The
Plaintiff’s brief on the impact of Sikes v. Teleline, Inc. on class
certification is due on August 30, 2002. The entire Order may be viewed Here. A
complete history of the action is also available by clicking here.
In
the past year, the AMA Dept. of Private Sector Advocacy has had an increase in
complaints from state and specialty societies concerning Anthem payment
procedures. The focus of the complaints are related to claims with modifiers
that Anthem has down coded or bundled in what the groups have seen as an effort
to avoid and delay payment of common claims. "Anthem's apparent arbitrary and
unilateral [and potentially inconsistent] application of CPT codes, guidelines
and conventions has created confusion and uncertainty and, based upon the
complaints we have received, has led to misunderstandings by physicians and
nonphysician health care professionals regarding Anthem's payment rates for
certain services," noted the letter, signed by the AMA and state, county and
specialty medical societies. For the complete article and a copy of the letter,
please go to www.ama-assn.org