Connecticut dentists, Anthem settlement awaits court's final approval
May 01, 2012
By Craig Palmer, ADA News staff
Southington, Conn.—Connecticut dentists and Anthem Health Plans, Inc., agreed to a $3.8 million settlement of lawsuits alleging that Anthem underpaid Connecticut dentists in violation of their provider agreements, the Connecticut State Dental Association said May 1 in a press release drafted by parties to the litigation.
The U.S. District Court for the Southern District of Florida preliminarily approved the class action settlement April 12 and scheduled a Sept. 13 hearing on final approval of the settlement. Court documents and notices posted on the settlement website invite dentists who were Anthem participating providers in Connecticut during the April 15, 1996-April 14, 2002, period to submit completed claim forms postmarked by Aug. 9, 2012.
Upwards of 2,300 Connecticut dentists are potential claimants, according to Carol Dingeldey, CSDA executive director. A court document referring to “numerosity” says that “the putative class includes more than a thousand dentists in Connecticut and is therefore so large that joinder of all members is impracticable within the meaning of (the) Federal Rules of Civil Procedure.”
A website notice on YOUR RIGHTS CONCERNING THE PROPOSED SETTLEMENT says:
“If you are or have been a dentist or dental Provider Group or Organization or other entity that provided (or arranged for the provision of) any services to any individual enrolled in or covered by a Dental Plan issued or administered by Anthem Health Plans, Inc., d/b/a Anthem Blue Cross and Blue Shield of Connecticut (“Anthem” or “Defendant”) pursuant to any Provider Contracts in force at any time during the period April 15, 1996 through April 14, 2002, your rights may be affected by a proposed settlement with Anthem Health Plans, Inc. in the class action lawsuit Martin J. Rutt, D.D.S. and Michael Egan, D.D.S., individually and on behalf of all others similarly situated v. Anthem Health Plans, Inc. d/b/a Anthem Blue Cross and Blue Shield of Connecticut, Case No. 1:02-CV-22065-FAM (the “Class Action Litigation” or “Action”), which is pending in the United States District Court for the Southern District of Florida (the “Court”).”
The settlement class includes “participating providers” of services enrolled in or covered by an Anthem-issued or -administered dental plan or plans pursuant to provider contracts in force at any time during the April 15, 1996-April 14, 2002 “Class Period.”
“You need not do anything to become part of the Settlement Class, but you must complete the Claim Form in order to be eligible to receive any benefit from the Settlement,” the settlement notice says. “If the Settlement is approved by the Court, the Settlement Agreement provides for both monetary and other benefits to be provided by Anthem to members of the Settlement Class.” The deadline for requesting exclusion from the class and for submitting objections is July 10, 2012 and for submitting claim forms, Aug. 9.
The CSDA also settled its suit against Anthem, Connecticut State Dental Association v. Anthem Health Plans, Inc., according to the press release.
“The primary allegation in both lawsuits was that Anthem violated its contracts with participating Connecticut dentists by underpaying those dentists for services they provided to Anthem dental plan members,” said the press release issued by CSDA but described as jointly drafted by the parties to the litigation.
“Anthem denied that this claim and the other allegations made by plaintiffs in the lawsuits had any merit and defended the claims in court,” the press release said. “Anthem does not in any way admit any wrongdoing.” An ADA News call to Anthem’s Washington D.C. legal counsel was not immediately returned.
The American Dental Association filed a “friend of the court” brief on behalf of the plaintiff dentists and state dental association asserting that the Employee Retirement Income Security Act of 1974 (ERISA) does not preempt state law claims of dentists and other health care providers that arise from their contracts with managed care plans.
“The ADA amicus brief and the hard work put in by Drs. Rutt and Egan on the lawsuit were a huge help,” said attorney Simon Allentuch of Neubert, Pepe & Monteith, which represented the Connecticut State Dental Association and Drs. Rutt and Egan.
Under the terms of the class action settlement, Anthem has agreed to modify and enhance certain administrative practices that are designed to improve transparency and communication in the claim payment process, the press release said. These efforts focus on Anthem’s web-based portals and seminars to help participating dentists more efficiently utilize the electronic claim payment process, thereby allowing for more focus on dental care.
Anthem also agreed to work with class representatives and the CSDA by establishing a Dental Advisory Group that will meet regularly to discuss issues that arise from the relationships among Connecticut participating dentists, their patients and Anthem, including issues related to claims processing and dental care, according to the press release.
“It is the parties’ hope and expectation that better communication will further foster a strong and mutually beneficial partnership between participating Connecticut dentists and the CSDA, on the one hand, and Anthem on the other, as they provide dental care in the State of Connecticut,” the press release said.