Notice of Proposed Class Action Settlement Involving Unfair PIP Reductions to Health Care Bills: MySpine vs USAA Casualty Insurance Company
By Jacob W. Gent
August 18, 2015
The Superior Court of Washington, Judge Theresa B. Doyle, recently published a “Notice of Proposed Settlement” related to a class action lawsuit against USAA that impacts the interests of BOTH patients and healthcare providers alike. The class action lawsuit challenged the ongoing and repeated reductions to health care bills submitted for payment by the patient and/or provider under a patient’s Personal Injury Protection (PIP) coverages of Washington auto insurance policies issued by USAA.
The Plaintiffs in this lawsuit include three Washington health care providers, MySpine, P.S, Olympic Physical Therapy, and Folweiler Chiropractic, P.S., and one individual, Lindsey Hayes, who carried PIP insurance with USAA. The Defendants include United Services Automobile Association (USAA), USAA Casualty Insurance Company, USAA General Indemnity Company, and Garrison Property and Casualty Company.
The interests of two (2) separate but related “classes,” or groups of Plaintiffs, are represented in this class action. The first consists of Washington health care providers who treated patients insured by USAA who were injured in a motor vehicle collision. The second class is comprised of USAA PIP insureds who were injured in motor vehicle collisions and were treated by the health care providers included in the first class.
The Plaintiffs state the Defendants improperly reduced payments of medical bills under the PIP coverage of their Washington auto insurance policies. The payment reductions were based on Defendants’ use of a computerized bill review process, known as the Milliman database, to determine the “reasonable fees” for health care services by comparing similar services rendered by healthcare providers within a given geographical area. The payment reductions at issue in this class action are designated by certain “Reason Codes” listed on the Explanation of Reimbursement or “EOR” form, issued by the Defendants. Specifically, Plaintiffs challenged Reason Codes with prefixes of “RF,” “RF_1,” and “RF_2.” The Defendants deny any liability or wrongdoing and maintain they have complied with their obligations under Washington law.
The parties have agreed to settle the lawsuit to avoid the cost, delay and uncertainly associated with continued litigation. However, there are major concerns that remain outstanding issues that are not addressed by the proposed settlement agreement. The time to speak up and speak out about these concerns is now, as the trial judge has set a hearing to consider whether or not to approve the proposed settlement. That hearing is scheduled to occur on September 11, 2015.
The concerns surrounding the proposed settlement is that it does not effectively deal with the underlying use of the software program Milliman to reduce and/or deny PIP or Medical Payments claims in Washington, and the proposed settlement does not outlaw the continued use of the Milliman database going forward in time. Further, if the Proposed Settlement becomes final, the lawsuit will be dismissed with prejudice, meaning the Defendants will receive a complete release and discharge of all claims and no further legal action may be brought against the same Defendants under this class action lawsuit.
Potential Class Members have several options available to them under the Proposed Settlement and should take immediate action to understand their legal rights before certain crucial deadlines affecting those rights expire. Detailed information regarding the Proposed Settlement may be obtained by calling toll free 1-866-346-8468 or visiting www.MySpineSettlement.com. Additionally, the attorneys at Adler Giersch, ps, are available to answer questions pertaining to this Notice of Proposed Settlement or other insurance and personal injury issues arising from the negligent conduct of others.