lindahalderman.com
| Commentary by | |
| Dr. Linda Halderman |
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Doctor wins court battle vs. CIGNA
Halderman, a breast cancer surgeon in Selma, received the notice on April 23 that stated "The court determines that defendant [CIGNA] underpaid plaintiff [Linda Halderman, M.D.] for services rendered. Plaintiff is entitled to recover damages." This comes after months of back and forth between the two parties, and finally the small claims court trial in Selma on April 6, where Halderman argued that CIGNA illegally downcoded her services, resulting in a significant cut in pay. According to Halderman, in March and April of 2006, she performed a minimally invasive biopsy on two separate CIGNA patients. The advantage of this procedure is that it can be done in a doctor's office instead of in a hospital. This not only saves the patient time and discomfort, compared to surgery, but the health care company also saves money. CIGNA saved even more money by changing Halderman's specified billing code assigned to a minimally invasive biopsy. Instead of paying Halderman around $600 for the procedure, CIGNA paid her just over $200 per patient. In addition to this financial cut from CIGNA, the procedure results in over $300 in disposable costs per patient for the doctor since the equipment cannot be reused. Because of this downcoding, Selma Superior Court Judge D. Tyler Tharpe awarded Halderman $800.40, the amount that CIGNA owed Halderman when she originally approached them right after the 2006 procedures regarding the downcoding. "I'm ecstatic, it's a real victory for my patients and such an important lesson," said Halderman. "It's a way to hold them accountable, so they aren't getting away with the things they do." In fact, CIGNA and nine other for-profit health plans were involved in the RICO (Racketeer Influenced and Corrupt Organizations) Act settlements that concluded in January of 2006. Those cases involved wrongfully denying payment to physicians through fraud and extortion practices like downcoding. According the Halderman, during those few days of communication, CIGNA originally agreed to pay Halderman $2,000, an amount Halderman requested from the health care company. Yet, the night before the court date Halderman received a fax from CIGNA revoking their verbal agreement. The two parties instead met at the Selma courthouse the very next day. "I felt like I had won already because I got to tell my story," Halderman said of her suit against CIGNA, regardless of the outcome. "However, I will never be able to make up what I lost in time, money and heartache. That will never be replaced." While she was awarded the $800, the reason she requested $2,000 was her desire to donate that sum to Selma's Cancer Support, the local organization that is just for Selma residents and their families who are affected by cancer. What sets this organization apart from other non-profit cancer support groups is that all the donations stay in Selma. The money is used to help cancer patients and survivors with anything and everything ranging from housing expenses to car payments and food. "We can put it to good use," Selma's Cancer Support founder Char Tucker said of the $2,000 that is pledged from Halderman. "We don't want to have to turn anyone away. We're really blessed to have Dr. Halderman in our group." Halderman had promised the donation to Selma's Cancer Support regardless of the final verdict. And while she hopes to put that $800 from CIGNA towards her donation, she's not holding her breath as to whether CIGNA will uphold their end of the bargain, once again. "They said they'd be paying, but the likelihood of them keeping their promise is low," Halderman said. "I suspect that their dishonesty up till now would be consistent." Because of this wavering confidence in the national health care organization, Halderman has enlisted the help of California State Insurance Commissioner Steve Poizner, who will look into CIGNA's statewide actions regarding downcoding and other foul play practices. If Halderman's case matches up with other reports found by Poizner and his associates throughout the year, then CIGNA could face sanctions, fines or even excluded from serving patients in California. While a verdict has been reached for Halderman in particular, she feels that cases like hers cannot be ignored or health care companies like CIGNA will get away with their misdeeds. "This is sort of a seed, and what I hope it does is it get others to come forward," Halderman said. May 2, 2007 |
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