Central United Cancer Care Plus
Central United Life Insurance Company is a division of the Manhattan Insurance Group. Central United sells a Cancer Care Plus policy that, according to their website “provides the covered individual diagnosed with cancer, and the family peace of mind by providing the benefits for necessary treatment and extra expenses.”
The Central United Life supplemental cancer policies provide for reimbursement of “actual charges” on claims for chemotherapy / radiation benefits. However, it appears that contrary to the terms of the policy, Central United has been paying only a portion of the charges, based on what the physician was paid by medical insurance or Medicare. Policyholders may have received only 30-40 percent of what they were owed.
Policyholders who filed a claim prior to 2002 received full benefits based on the amount that appeared on the physician’s bill (“actual charges”). The payment of benefits did not depend on the discounted payments of medical expenses by other major medical insurance.
Since the change in the adjusting practices of some supplemental cancer insurance companies, the benefits are now paid on what the physician accepts as full payment for the services. Thus, the supplemental cancer insurance companies now pay benefits based on the amount accepted by the treating physicians, or better stated, benefits are paid based on the discounted amount other insurance companies pay.
As an example, pursuant to the previous adjusting practice, if the doctor billed $10,000 for a procedure, the companies would pay $10,000, regardless if the physician accepted less for his service.
Under the new adjusting practice, if the physician bills $10,000 and later only accepts $3,000 as full payment, the supplemental cancer insurance company will only pay $3,000.
Central United Life Class Action
A class action notice known as Skelton v. Central United Life Insurance Company was mailed to policyholders who possessed a policy during the timeframe of February 2003 through April 2008.
This class action would settle for all policyholders any dispute over claims for benefits. This settlement would affect any current claims, and also any future claims or disputes.
Under the new adjusting practice, if the physician bills $10,000 and later only accepts $5,000 as full payment, the supplemental cancer insurance company will only pay $5,000.
We would encourage all Central United Life class members to review the proposed settlement agreement and consult a qualified attorney if they have any questions or concerns.
While the details and circumstances surrounding each case vary, policyholders may be better served by “opting out” of the class action and pursuing an individual claim. Policyholders must “opt out” of this class action by the June 3, 2008 deadline in order to pursue an individual claim.
Free Legal Consultation
If you purchased a policy through Central United Life Insurance Company, you need to act quickly to ensure that your rights are protected. If you or a loved one is a Central United Life policyholder and you have questions about the proposed class action settlement, we would encourage you to contact us today for a free legal consultation.