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Case Puts Doctors Back in the Driver’s Seat

Edith Kallas and Joe Whatley were also featured in a National Law Journal article entitled “Case Puts Doctors Back in the Driver’s Seat” for their work in restoring doctors’ power to make important medical decisions about their patients’ treatment without the interference of health plans. The article details a string of settlements Kallas and Whatley reached with the vast majority of the managed care companies in the country in the massive multi-district litigation In re Managed Care Litigation, whereby the companies were required to fundamentally and permanently change the way they interact with and pay doctors. In addition to requiring insurers to compensate a class of over 900,000 physicians for past underpayments and to change their payment practices going forward, the settlements all required insurers to adopt a definition of medical necessity based on generally accepted medical standards, and to allow independent medical experts to decide appeals when insurers deem treatments not medically necessary, thus placing important treatment decisions back in the hands of doctors rather than insurers.