 |
|
FREQUENTLY ASKED QUESTIONS
1. How or why would I be a part of this Class Action Settlement? You have been identified by a review of records available to Nationwide/Allied as having made a claim for insurance benefits under Medical Expense Coverage to Nationwide/Allied, or as a medical provider to a Nationwide/Allied insured. Such Medical Expense Coverage claims were often made under auto policies providing personal injury protection or medical payments coverage, but were also made under other types of coverage. One or more of the medical bills that you may have submitted, or that a medical provider may have submitted on your behalf, could possibly be a part of the claims identified as containing charges for services that may have been reduced based upon a medical bill review or audit which indicated that the amount charged exceeded the reasonable or usual and customary charges for the region where the services were provided, or that the charges were subject to agreed pricing under a preferred provider organization (“PPO”) or similar agreement. 2. What are the Lawsuits about? The Lawsuits claim that Nationwide/Allied improperly reduced or denied insurance benefits for medical or rehabilitative services after submitting medical bills to medical review vendors. Specifically, the Lawsuits challenge payment reduction of those services based upon a reasonableness or usual and customary charge review, or based upon application of agreed pricing under a PPO or similar type of pricing agreement administered by CorVel Corp. Among other things, the Lawsuits challenge Nationwide/Allied’s right to conduct such bill review under the applicable policies, the disclosure that such bill review will be conducted, or the manner in which the bill review was conducted. Nationwide/Allied denies any wrongdoing, and contends that review of medical bill pricing protects against excessive charges and helps to preserve insurance benefits. The Courts have made no final rulings on the merits of claims or defenses made in the Lawsuits. The Courts have preliminarily approved the claims to proceed as a class action for settlement purposes only. If the settlement is not approved, the courts presiding over the Lawsuits will have to decide whether any of the Lawsuits should be treated as a class action for the purpose of addressing the merits and possibly conducting trials of the Lawsuits. 3. Why is this a class action? In a class action, one or more people called class representatives sue on behalf of people whom they believe have similar claims. All of these people are a class or class members. The Courts in charge of the Garza Action and Cashman Action will resolve the issues for all class members, except for those who exclude themselves from the class. The “Class Representatives” appointed by the Courts to represent the interests of all class members are the Plaintiffs who filed the Lawsuits: Yolanda Garza, Acuna, P.T., Gerald H. Bemis, Sr., D.C., Mark J. Eavenson, D.C., d/b/a Multi-Care Specialists, P.C., and Macaela Cashman. Ms. Garza and Ms. Cashman are persons who were insured by Nationwide/Allied under Medical Expense Coverage. The other Class Representatives are medical providers who provided medical services to persons insured by Nationwide/Allied under Medical Expense Coverage. The Courts did not decide in favor of Plaintiffs or Defendants. Instead, both sides agreed to a settlement. That way, they and the Settlement Class Members (defined below) avoid the risk, delay, and expense of continuing the Lawsuits, and the Settlement Class Members will be eligible to receive compensation. The named Plaintiffs, on their own behalf and on behalf of all Settlement Class Members, have entered into a Stipulation of Class Action Settlement (“Settlement Agreement”) with Nationwide/Allied, which has been preliminarily approved by the Courts. The Class Representatives and Class Counsel think the settlement is best for all Settlement Class Members. This notice summarizes the terms of the Settlement Agreement, your rights and obligations thereunder, and the process by which the Courts will determine whether or not to enter a final approval of the Settlement Agreement. Both Courts presiding over the settlement issued injunctions in their Preliminary Approval Orders restricting Class Members from pursuing certain claims covered by the proposed settlement. The full text of those Preliminary Approval Orders and incorporated injunctions is available at [Cashman Preliminary Approval Order] [Garza Preliminary Approval Order]. 5. Can I file my own lawsuit or demand? No, you cannot file your own lawsuit unless you follow the procedures set forth in Question 11 to submit a Request for Exclusion from the Settlement Class. 6. How do I know if I am covered by the settlement? You are a member of the “Settlement Class” and a “Settlement Class Member” covered by the settlement if you fall within the following class definition adopted by the Courts:
7. What does the settlement provide? Payments (“Settlement Payments”) will be made to Settlement Class Members who timely submit Claim Forms as explained below. The settlement also protects insureds of Nationwide/Allied from certain claims and balance billing from their medical providers as explained in the Release attached to the notice as Appendix A. 8. How much would my Settlement Payment be? Settlement Class Members who do not exclude themselves from the settlement and who submit a valid Claim Form will be eligible to receive the following Settlement Payments:
Amounts claimed must be supported by documentation and/or a sworn statement sufficient to verify and quantify the amount claimed, and are subject to the limitations set forth in the Settlement Agreement (as summarized in this notice and the Claim Form instructions). “Covered Claim” means: (i) claims where the amount paid was a reduced amount based upon a review of the price or the amount charged for medical or rehabilitative services or products, including without limitation reduction of amounts paid based upon reasonableness, usual and customary charges, or geographic scope determinations; and (ii) claims where the amount paid was a reduced amount based upon the application of the CorVel PPO network or other pricing arrangements administered through CorVel Corporation. Expressly excluded from Covered Claims are charges reduced or denied based upon: coverage denials, exhaustion of policy limits, application of a government-sanctioned fee schedule, necessity or relatedness of treatment, independent medical examination, peer review, and insured deductible, co-pay or other contribution requirements under applicable law or policy terms. The amount of Settlement Payments on all valid Claim Forms arising under any insured’s Medical Expense Coverage claim shall not exceed the amount of available unpaid coverage limits, if any, in effect for the underlying Medical Expense Coverage claim. And any such Settlement Payments may be applied against remaining unpaid coverage. In the event valid claims submitted exceed the available unpaid coverage, then all such valid claims shall be paid pro rata based upon the amount of remaining unpaid coverage limits. Any amounts claimed but not supported by documentation sufficient to verify all amounts claimed and due as a Settlement Payment shall be deemed an Undocumented Claim Form. Settlement Payments on Undocumented Claim Forms shall not exceed the greater of $50.00 or the documented portion of the Covered Claim. There is no cap on the aggregate amount of claims Nationwide/Allied will pay under the Settlement Agreement. Claims will not be reduced or paid pro rata based on the total amount of claims submitted under the proposed settlement. The above Settlement Payments shall be the only payments to which any Settlement Class Member may be entitled. 9. How can I get a Settlement Payment?-- This deadline has passed To qualify for a Settlement Payment, you must send in a Claim Form. If you have multiple claims, you may use copies of the Claim Form. You may obtain a Claim Form on this website by clicking here [Class Notice and Insured Claim Form] [Class Notice and Provider Claim Form]. Read the instructions carefully, fill out the form, include all the documents the form asks for, sign it, and mail it by the deadline set forth below. Your completed Claim Form(s) must be sent by First-Class Mail, postage prepaid, and postmarked no later than June 20, 2008 and must be addressed to the Settlement Administrator, c/o Rust Consulting, Inc., P.O. Box 158, Minneapolis, MN 55440-0158. Any extensions of the claim deadline will be posted on this website and on a recorded message at 1-877-625-9426. 10. What documentation must accompany the claim form?-- This deadline has passed To be eligible, you are required to submit copies of documentation that verifies the amount charged, the amount allowed or paid by Nationwide/Allied, and the reason for the reduced payment. The best evidence of that information is typically the most recent Explanation of Review (which may also be called the Explanation of Benefits or Reimbursement) provided to you when the claim was adjusted. You should also provide any documentation that shows any updates to that review which resulted in additional or modified allowance or payment for those medical services. If you believe that you are eligible for a Settlement Payment but do not possess sufficient documentation, you must include with your Claim Form a sworn affidavit setting forth or explaining the amounts billed, the amounts allowed or paid, any reduction, and the reason provided by Nationwide/Allied for the reduction. Any claim not supported by documentation sufficient to verify all amounts claimed and due as a Settlement Payment shall be deemed an Undocumented Claim Form. Settlement Payments on Undocumented Claim Forms shall not exceed the greater of $50.00 or the documented portion of the Covered Claim. The Settlement Administrator will evaluate each timely Claim Form submission and calculate the amount due as a Settlement Payment. You will be notified of any defects in your Claim Form submission that preclude or limit the award of a Settlement Payment, and will be provided 60 days to cure your claim. 11. If I don’t have documentation, how will that affect my payment? Any claim not supported by documentation sufficient to verify all amounts claimed and due as a Settlement Payment will be deemed an Undocumented Claim Form. Settlement Payments on Undocumented Claim Forms shall not exceed the greater of $50.00 or the documented portion of the Covered Claim. 12. If I have documentation for some of my doctor visits but not for others, how will that affect my payment? You will be paid only for the documented portion of your claim, or $50, whichever is greater. For example, if you have documentation for doctor visits totaling $200, and undocumented doctor visits totaling $100, your claim will only be eligible for the documented portion. However, if you have documented visits totaling $25 and undocumented visits totaling $200, a payment would not be greater than $50. 13. When would I get my Settlement Payment? Claims will be reviewed by the Settlement Administrator and payments issued only after the settlement is approved by the Courts and any appeals are resolved. Please be patient, this process could take a long time. Updates will be provided on this website and at this toll free number: 1-877-625-9426. Claims are currently being reviewed. Distributions will begin in December 2008. 14. Do I have a lawyer in this case? The Courts have appointed the following law firms to represent you and the other Settlement Class Members: Feazell & Tighe LLP, Freed & Weiss LLC, The Lakin Law Firm, P.C., and McNamara, Goldsmith, Jackson & Macdonald, P.C. These lawyers are called Class Counsel. You will not be charged for these lawyers. If you want to be represented by your own lawyer, you may hire one at your own expense. 15. How will the lawyers be paid? Nationwide/Allied will pay Class Counsel’s fees and expenses up to the amount approved by the Courts. Class Counsel will ask the Courts to approve a total collective payment to their firms of attorneys’ fees and expenses up to $7,800,000. The Courts may award less than the amount requested. 16. Why are some states excluded? Some states are excluded due to separate class action judgments issued in those states; others are excluded because they are fee-schedule states. 17. If I lived in an included state and I have medical bills that seem to fit the criteria, but now live in one of the excluded states, can I participate in the settlement?-- This deadline has passed You most likely will be able to participate. Probably Yes. You should submit a Claim Form;. If your claim is not covered, you will be provided an explanation of why it is not covered. 18. If I lived in an excluded state but now live in an included state and I have medical bills that seem to fit the criteria, what should I do?-- This deadline has passed You should submit a Claim Form. If your claim is not covered, you will be provided an explanation of why it is not covered. 19. What are my current options?-- All deadlines have passed
20. How do I get out of the settlement? -- This deadline has passed If you do not want settlement relief, but you want to keep the right to sue, on your own, about the legal issues released and dismissed by this settlement, then you must take steps to get out. This is called excluding yourself -- or is sometimes referred to as “opting out” of the Settlement Class. You cannot exclude yourself by phone or e-mail. To exclude yourself from the Settlement Class, you must make your request in writing. A request for exclusion must contain the following: (1) the Settlement Class Member’s name, and any former names under which the Settlement Class Member may have been insured by Nationwide/Allied (if insured) or any former names, fictitious names, or other names under which medical bills may have been submitted to Nationwide/Allied (if a provider); (2) the Settlement Class Member’s policy number or last four digits of the Settlement Class Member’s Social Security Number (if a person) or Tax I.D. number (if an entity); (3) the Settlement Class Member’s address; (4) the Settlement Class Member's expression of the desire to opt out or be excluded from the Settlement Class; and (5) the Settlement Class Member’s signature or the signature of an authorized representative of the Settlement Class Member. A separate request for exclusion must be submitted for each person or entity who wants to be excluded from the settlement. Your written request for exclusion must be sent by First-Class Mail, postage prepaid, and postmarked no later than February 21, 2008 and must be addressed to the Settlement Administrator at: Settlement Administrator, c/o Rust Consulting, P.O. Box 158, Minneapolis, MN 55440-0158. 21. If I exclude myself, can I get money from the settlement? No. If you ask to be excluded, you will not be eligible for any Settlement Payment, and you cannot object to the settlement. You will not be legally bound by the settlement or anything that happens in the Lawsuits. 22. If I don’t exclude myself, may I sue for the same thing later? No. If you do not exclude yourself, you will give up the right to bring or continue claims or lawsuits resolved by this settlement. If you have a pending lawsuit, speak to your lawyer in that case immediately about this settlement. 23. How do I object to the settlement? -- This deadline has passed If you are a Settlement Class Member, you can object to the settlement if you don’t like any part of it. You can give reasons why you think the Courts should not approve it. The Courts will consider your views. To object, you must submit a written statement containing the following: (1) a prominent identifying reference to the case, as follows: “Nationwide/Allied Medical Expense Coverage Settlement”; (2) the Settlement Class Member’s name; (3) the Settlement Class Member’s policy number or last four digits of the Settlement Class Member’s Social Security Number (if a person) or Tax I.D. number (if an entity); (4) the Settlement Class Member’s address; (5) a statement of each objection being made and any supporting documents; (6) a statement indicating whether the Settlement Class Member intends to appear at the Fairness Hearing to be held by the Court presiding over the Garza Action; and (7) a list of witnesses whom the Settlement Class Member may call by live testimony and copies of any documents or papers that the Settlement Class Member plans to submit. You must submit your objection to the Settlement Administrator, Class Counsel, and Counsel for Nationwide/Allied, as identified below, by First-Class Mail, postage prepaid, postmarked no later than February 21, 2008, as follows:
The Settlement Administrator will file objections with the Courts for their consideration. Your objection will not be considered by the Courts if you do not follow these procedures. 24. What is the difference between objecting and excluding? Objecting is simply telling the Courts that you do not like something about the settlement. You can object only if you stay in the Settlement Class. Even if you object, you may still submit a Claim Form and you will still be bound by the settlement if it is approved by the Courts. If you exclude yourself, you have no basis to object because the settlement no longer affects you. If you do nothing, you will get no money from the settlement. But, unless you excluded yourself, you won’t be able to start a lawsuit, continue with a lawsuit, or be part of any other lawsuit against Nationwide/Allied and the Released Parties about the legal issues in the Lawsuits and the Released Claims, ever again. 26. Are there tax consequences for me if I participate in this Lawsuit? The Settlement Payments described could have tax consequences for you. Those tax consequences may vary, depending upon your individual circumstances. You should consult your own tax advisor regarding any tax consequences of the settlement, including any Settlement Payments or benefits provided under the settlement, and any tax reporting obligations you may have with respect thereto. The parties make no representations, and assume no responsibility, with respect to any tax consequences that may occur. 27. The person to whom the Notice was sent is deceased. What should I do? You may submit a claim on behalf of the estate. Please enclose with your Claim Form a copy of the death certificate and any other documents you may have, such as a document appointing you Personal Representative, or an Affidavit of Heirship. 28. The Settlement Class Member listed is incapable of acting on his/her own behalf. I have Power of Attorney. What should I do? You may submit a claim on behalf of the Settlement Class Member. Please enclose with your Claim Form a copy of your Power of Attorney. 29. How can I get more information? More details are in the Settlement Agreement. You can get a copy of the Settlement Agreement on this website [Notice of Filing Stipulation of Class Action Settlement] [Notice of Filing Stipulation of Class Action Settlement] or by writing to the Settlement Administrator. You may call 1-877-625-9426 toll free for additional information or you may address questions in writing to the Settlement Administrator, c/o Rust Consulting, Inc., P.O. Box 158, Minneapolis, MN 55440-0158. Updates regarding the Settlement will be posted on this website and summarized in a message provided on the toll free number. Click here for a link to the: Insured Class Notice and Claim Form or Provider Class Notice and Claim Form |
