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: Connecticut dentists will receive $3.8 million as part of a settlement stemming from a lengthy battle between dentists, a dental association and an insurance provider.
The class action was brought by Connecticut dentists who had contracts with Anthem Health Plans in the 1996 to 2002 time frame. The lawsuit claimed that Anthem violated its contracts by underpaying dentists for services they provided to Anthem dental plan members.
The class action, with two Connecticut dentists — Martin Rutt and Michael Egan — as name plaintiffs alleged breach of contract, breach of the duty of good faith and fair dealing, and a violation of the Connecticut Unfair Trade Practices Act.
Anthem Health Plans denied any wrongdoing and said it provided fair payment for the services. However, the dentists and dental associations said the amount was less than the “usual, customary and reasonable fee,” or UCRs, that were outlined in their contracts with Anthem. Anthem was calling the payments a “maximum allowable amount.”
One of the plaintiffs’ lawyers, Simon I. Allentuch, of New Haven-based Neubert, Pepe & Monteith, explained that the lawsuit was initially filed in New Haven Superior Court in 2002 and was later transferred to a multi-district litigation docket in federal court in Florida before Judge Federico A. Moreno in Miami. Allentuch said the Connecticut case, along with several other similar cases against insurance providers, were combined in Florida.
Settlement discussions never gained any ground until 2011, according to court documents. In 2012, a $3.8 million settlement was reached. It received final approval from Judge Moreno late last year.
As part of the settlement, Anthem Health Plans did not admit wrongdoing. Its lead attorney, E. Desmond Hogan, of Hogan Lovells in Washington, D.C., did not return calls seeking comment. Hogan was assisted by Michael G. Durham, of Donahue, Durham & Noonan in Guilford, Conn.
The payment of the $3.8 million to the eligible Connecticut dentists will be overseen by a claims commissioner in the U.S. District Court in Florida. Dentists eligible for funds include those who had contracts with Anthem between April 15, 1996 and April 14, 2002.
Also, in order to settle a separate pending state court lawsuit filed against Anthem in 2002 by the Connecticut State Dental Association, Anthem will pay the dental associaiton $200,000.
Allentuch said on average, the settlement terms could pay each eligible dentist anywhere form $3,000 to $3,400. About 17 percent of the settlement will go for plaintiffs attorney fees.
Assisting Allentuch in Connecticut was Michael Neubert, also of Neubert, Pepe & Monteith. Miami lawyer John B. Ostrow also represented the plaintiffs.
Allentuch said after the lawsuit was filed, Anthem changed the way dentists were paid for services. They were again paid consistently with the terms of their contractual agreements. Allentuch noted that the contracts now require a fee schedule for services rather than UCRs.
Also as part of the settlement agreements, Anthem has implemented administrative practices designed to improve transparency and communication in the claims payment process. These efforts center around the company’s website and seminars to help participating dentists more efficiently utilize the electronic claim payment process.
Finally, Anthem has agreed to work with class action representatives and the Connecticut State Dental Association to form a Dental Advisory Group that will meet regularly to discuss issues that arise from relationships between Connecticut dentists, their patients and Anthem, including issues pertaining to processing claims and dental care.
“I think it was actually a long and hard-fought case,” said Allentuch. “The dentists in Connecticut I’ve spoken to are pleased with the outcome and the fact we were able to settle it on a favorable basis for Connecticut dentists.”•