12 I Summer 2019 www.anjc.info Medicare Q&A Medicare Update INSURANCE Update INSURANCE Update DOBI Complaints: With the myriad of serious issues in insurance authorizations and reimbursements that have arisen in 2019, it is imperative that providers and patients make the authorities aware of these problems. The best way to do this is to file a complaint with New Jersey’s Department of Banking and Insurance (DOBI). There are no costs or prerequisite requirements to do this. There is simply a one-page form that can be sent electronically, by fax or by mail. To assist members in making their concerns heard by DOBI, we have provided links to the complaint forms, example completed complaint forms, step-by-step instructions and a brief webinar on how to complete and file these complaints. These materials can all be found at our website, www.anjc.info, under the Insurance tab > Appeals & Forms > Complaints. ASHN-CIGNA Class Action Lawsuit: In early April we learned that a settlement had been reached in a class action lawsuit against CIGNA and ASHN regarding improper utilization review and claim processing procedures of out-of- network chiropractic claims. There will be a monetary settlement of $11.75 million dollars that will be distributed on a pro rata basis to out-of-network chiropractors who had submitted claims between 2009- 2015. There are also four actions that ASHN will take going forward as a result of the settlement. 1. ASHN will expand its Advisory Committee to include more stakeholders, specifically from the chiropractic profession. 2. ASHN will provide no-cost CEUs to chiropractors. 3. ASHN will make reasonable efforts to gather feedback from OON chiropractors on how to improve their claims process. 4. ASHN will provide educational webinars on how to use their utilization management review tools. Postcards have been sent regarding the settlement to the members of the class. Below is a summary of the postcard’s information and instructions. Who is included in the Class Action Settlement? Class members include all out-of-network chiropractic providers who provided clinical services to a CIGNA plan member, whose claims for reimbursement of such services were subjected to the ASH policies or practices as part of the claims review or benefit process, and where some or all of the claim was denied. What do I have to do? You do not have to do anything. If you are part of the class as defined and wish to accept the settlement as reached, you will receive a pro-rated portion of the settlement based on the amount of your effected claims relative to the entire class. IMPORTANT NOTES: 1. If you accept the settlement and do not OPT OUT, then you are surrendering any rights to pursue your own legal action against CIGNA or ASHN on these matters. If you wish to OPT OUT and preserve your right to your own legal action on these claims you must contact the settlement administrator to request exclusion no later than July 10, 2019. You can reach the settlement administrator at www.highstreetchirosettlement.com, by email at info@HighStreetChiroSettlement.com or by phone at 1-888-208-9083. 2. You can stay in the class but dispute your estimated payment by submitting a request in writing and providing evidence of the total claims for reimbursement of clinical services which were subjected to the ASHN policies or practices as part of the claims review or benefit determination process where some or all of the claim was denied. You would also contact the settlement administrator for this. For more information on this settlement, contact information for the settlement administrator and the attorneys involved as well as the full court documents, please visit the settlement administrator website at www.highstreetchirosettlement.com By Matt Minnella ANJC Director of Insurance & Regulatory Affairs Summer Insurance Update