Additional Information about Physician Settlement
IF YOU ARE A PHYSICIAN WHO PROVIDED COVERED SERVICES TO ANY INDIVIDUAL ENROLLED IN OR COVERED BY CERTAIN HEALTH CARE PLANS AT ANY TIME BETWEEN AUGUST 4, 1990 AND MAY 10, 2005, OR A PHYSICIAN GROUP OR A PHYSICIAN ORGANIZATION THAT INCLUDES SUCH PHYSICIANS, PLEASE READ THIS INFORMATION CAREFULLY.
If you are or have been a physician, physician group, or physician organization who or which practiced in the United States since August 1990, your rights may be affected by a proposed settlement with Health Net, Inc. in a class action lawsuit. In addition to Health Net, Inc., the Action involves all of the direct and indirect subsidiaries and affiliates of Health Net, Inc. involved in the health care business. You may be a member of the Health Net settlement class in this Action if you have submitted claims to certain Health Net entities or other managed care companies.
The class representatives and certain medical societies have agreed to settle all claims against Health Net in the Action in exchange for Health Net's adoption of a number of commitments and initiates regarding its business practices and the establishment of settlement funds against which individuals who are members of the Class can make claims for a settlement payment. The Class is defined as: any and all physicians, physician groups and physician organizations who provided covered services to any plan member or any other individual enrolled in or covered by a plan offered or administered by any person or entity named as a defendant in the Action or by any of their respective current or former subsidiaries or affiliates, in each case from August 4, 1990 through and including May 10, 2005.
If you are a Participating Physician, or if you are a Physician Group or Physician Organization that consists of 5 or less Participating Physicians, and you have an Individually Negotiated Contract with Health Net, the following applies: The MDL Settlement Agreement does not modify or nullify the individually negotiated terms of your contract. You have the option to notify Health Net in writing, specifically setting forth the negotiated terms in your contract that you want to have modified or nullified by the MDL Agreement. Upon such specific written notification, either you or Health Net may then elect to renegotiate your contract or terminate it.
If you are a Physician Group or Physician Organization with more than 5 Participating Physicians, and you have an Individually Negotiated Contract with Health Net, the following applies: Your contract is not subject to amendment or renegotiation, but upon written request made within sixty (60) days of the Final Order and Judgment, Health Net will provide to you the same rights as Participating Physicians have under all of the following sections of the MDL Settlement Agreement: 7.10 (Billing Dispute External Review Board), 7.11(c) (external review board), 7.13(a) (credentialing), 7.28(b) & (c)(capitation), 7.29 (a)("gag" clauses), 7.29(b) (ownership of medical records), 7.29(f) (privacy of records), 7.29(g) (pharmacy risk pools, provided that pharmacy risk pools in existing contracts will not be amended or terminated by this provision), and 7.29(l) (copies of contracts). Any such written request to have your contract changed must include all of the listed sections; the MDL Settlement Agreement requires that these sections be taken together as a package; it does not give you the right to select some but not all of these provisions.
Any written requests for contract changes must be addressed to the following: Physician Settlement Contract Request, P.O. Box 42, Minneapolis, MN 55440-0042. Health Net will make every effort to respond to your written request within 30 days. If you do not hear from Health Net within 30 days after your written request, please contact your local Health Net representative.