Anne Bucher  |  January 14, 2015

Category: Closed Class Actions

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This settlement is closed!

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Coventry Health

A settlement has been reached in a class action lawsuit alleging Coventry Health Care Inc. incorrectly calculated the reimbursement it owed providers for certain workers’ compensation medical bills under the terms of its First Health PPO Provider Agreement. If you have been reimbursed for certain workers’ compensation medical bills through a First Health PPO Provider Agreement, you may be eligible for a payment from the class action settlement.

Coventry is a health benefits company that maintains a network of providers, including doctors, hospitals and other facilities. Coventry enters into provider agreements with these health care providers, at which point they become members of the First Health Network.

The Coventry class action lawsuit alleged that the health benefits company incorrectly determines the “maximum amount payable” under workers’ compensation rules and guidelines whenever a provider submits a billed charge for a service that is less than the amount specified for that service under the relevant state’s fee schedule. According to the plaintiffs, Coventry cannot apply a discount (as stated in its provider agreement) to the provider’s billed charge when that charge is less than the state or federal fee schedule amount.

Coventry denies that it has violated the PPO provider agreement but has agreed to settle the class action lawsuit to avoid the cost and risk of a trial. Under the terms of the class action settlement, Coventry will pay $8.5 million to eligible Class Members.

Who’s Eligible

Class Members of the Coventry class action settlement include health care providers who:

  • Have or had a First Health provider agreement which has an Appendix A that uses the term “maximum amount payable” in the language about reimbursement for services provided to occupationally ill or injured employees; and
  • Have had bills discounted under that provider agreement from March 25, 1999 to Sept. 3, 2014 by Coventry’s discounting the billed charge when that charge was less than the state or federal fee schedule amount.

The Settlement Class is divided into three groups: 1) Notified Class Members, 2) Self-Identified Class Members, and 3) Actual Damages Class Members.

Potential Award

Class Members who received a Settlement Notice in the mail will automatically receive a payment of $50 and do not need to submit a Claim Form to receive the payment.

Class Members who did not receive a Settlement Notice must file a claim to be eligible for benefits. Self-Identified Class Members who submit documentation will be eligible to receive a proportional share of the $5 million Guaranteed Fund after all Notified Class Members are paid.

Actual Damages Class Members who submit documentation will be eligible to receive up to the amount of their actual damages from the Individual Claim Fund. Coventry has agreed to contribute up to $3.5 million to the Individual Claim Fund.

Proof of Purchase

If you received a notice about the Coventry class action settlement in the mail, you do not need to do anything to receive a $50 payment. However, you must submit a Claim Form if you wish to claim additional settlement benefits.

To file a claim as a Self-Identified Class Member, you will need to provide supporting documentation including copies of sections of your First Health PPO provider agreement and applicable appendix.

When filing a claim for an Actual Damages payment, you must prove that you have had bills discounted under your First Health provider agreement from March 25, 1999 to Sept. 3, 2014. Coventry must have discounted the billed charge when the charge was less than the state or federal fee schedule amount.

Claim Form Deadline

3/18/2015

Case Name

Chehalem Physical Therapy Inc. v. Coventry Health Care Inc., Case No. 3:09-cv-320-HU, in the U.S. District Court for the District of Oregon

Final Hearing

9/3/2014

Settlement Website

www.CoventrySettlement.com

Claims Administrator

Coventry First Health Settlement
c/o Rust Consulting Inc.
P.O. Box 1914
Faribault, MN 55021-1941
1-866-430-8454
Administrator@CoventrySettlement.com

Class Counsel

Steve D. Larson
Joshua L. Ross
STOLL STOLL BERNE LOKTING & SCHLASTER PC

Diana E. Godwin
LAW OFFICES OF DIANA E. GODWIN

Thomas A. Filo
COX COX FILO CAMEL & WILSON LLC

Stephen B. Murray
Arthur M. Murray
Korey A. Nelson
Stephen B. Murray Jr.
MURRAY LAW FIRM

Joseph Payne Williams Sr.
Richard Bray Williams
WILLIAMS FAMILY LAW FIRM LLC

Defense Counsel

V. Robert Denham Jr.
Jennifer A. Adler
ROBINS KAPLAN MILLER & CIRESI LLP

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Please note: Top Class Actions is not a settlement administrator or law firm. Top Class Actions is a legal news source that reports on class action lawsuits, class action settlements, drug injury lawsuits and product liability lawsuits. Top Class Actions does not process claims and we cannot advise you on the status of any class action settlement claim. You must contact the settlement administrator or your attorney for any updates regarding your claim status, claim form or questions about when payments are expected to be mailed out.