Connecticut Doctors’ Groups File Suit Against Six HMOs
Two Connectiut physicians' groups filed lawsuits yesterday against six large HMOs -- Aetna U.S. Healthcare, Oxford Health Plans, Cigna HealthCare, ConnectiCare, Anthem Blue Cross and Blue Shield and Physician Health Services -- accusing the companies of "systematically harm[ing]" patients by "arbitrarily denying crucial medical treatment" and "illegally withholding millions of dollars in payments to doctors," the New York Times reports. The lawsuits, filed in conjunction with the state attorney general's office, comprise one of the "broadest legal challenges" to the health insurance industry. The Connecticut State Medical Society filed six lawsuits, one against each HMO, seeking to stop "unfair, deceptive, improper practices" at the six companies. In addition, a group of doctors filed five separate suits, which seek to "enjoin the same six HMOs from those practices" and ask the courts to order the companies to pay millions of dollars in damages to doctors still "waiting for reimbursement" for their services.
According to Timothy Norbeck, executive director of the state medical society, doctors hope to "force" the HMOs to "fundamentally change" their operations -- including alleged "arbitrary denial of medically necessary care, denial of care without proper explanation," allowing clinic staffs to "deteriorate to dangerous levels" and withholding payments from doctors in violation of Connecticut's Unfair Trade Practices Act. "These suits take direct aim at health plan policies and practices that place critical medical care decisions in the hands of insurance company bureaucrats instead of physicians, where they belong," he said (Zielbauer, New York Times, 2/15). Jim Hartley, another medical society attorney, added, "The heart of this action goes to the effect these systemic practices have on patient care" (AP/Hartford Courant, 2/14).
Keith Stover, a lobbyist for the Connecticut Association of Health Plans, expressed disappointment over the lawsuits, contending that they "had more to do with the wishes of trial lawyers' associations" than with health care concerns. "Connecticut has probably the most advanced patient protection statutes in the country," he said, adding, "The claims are, at best, hyperbolic, and at worst they're just disingenuous." Aetna issued a statement "expressing disappointment" that the medical society filed suit before bringing its grievances to the company's attention, adding, "We believe that suits such as this one are without legal merit and we will, of course, vigorously pursue our defense" (New York Times, 2/15). Oxford officials said that the company "eliminated most denials of claims" after patients have received care, adding that it pays most "routine" claims within one week. According to Cigna, medical professionals make all of the HMO's medical decisions, and the company "tries to pay claims promptly and accurately" (Philadelphia Inquirer, 2/15).
The American Medical Association supports the litigation, expressing hope that physicians' groups in other states would join the suits. "What the physicians of Connecticut have said is that they've tried a number of solutions and none of them have worked," Dr. D. Ted Lewers, chair of the AMA's board of trustees, said, adding, "It is getting to the point where quality of care is being threatened." Although physicians' groups and doctors have often filed lawsuits against HMOs, according to Connecticut Attorney General Richard Blumenthal(D), no other series of suits have used "this kind of double-barreled legal barrage" by a state medical society and a group of its member doctors to force "similar reforms against an unusually large number of health care companies." In addition, most other lawsuits against HMOs have not sought "wholesale changes in how the companies operated," he said. Calling the HMOs "ripe for ... legal challenge," Melvin Weiss, a lawyer for the medical society, said, "We have a lot of weapons to get reform. They are not going to be able to run away from this" (New York Times, 2/15).