Group of doctors sues to change managed care

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Posted 8:32AM on Friday, April 26, 2002

NASHVILLE - Tennessee's largest physician's organization sued the state's four biggest health insurers Thursday, alleging their managed care practices threaten patients' health. The Tennessee Medical Association's class-action lawsuits filed in state court name Aetna Inc., Blue Cross Blue Shield of Tennessee, CIGNA HealthCare and United HealthCare. They allege that because of the "extraordinary unequal bargaining positions" between the medical association and the insurance companies, the association's 6,600 members are forced into entering one-sided contracts. The association says the four companies comprise 70 percent of the HMO market in Tennessee and insure nearly 2.4 million people in managed care plans across the state. The lawsuits seek to stop a number of business practices that TMA alleges delay, deny or reduce payments to physicians. For example, they claim the insurance companies "bundle" several physician services together to lower reimbursements and deny higher reimbursements for complicated medical cases in which doctors spend extra time and resources. Ron Harr, a spokesman for Blue Cross Blue Shield, said he had not seen the lawsuit and could not comment in detail, but he called it "shortsighted." "We do everything we can do to keep health insurance affordable," he said. Representatives of United, Aetna and CIGNA said they had not seen the lawsuits and declined comment. Dr. Mickey McAdoo, president elect of the TMA, said the association and its individual members have been bringing their concerns to the insurance companies almost daily, but to no avail. In addition to the TMA lawsuits, four individual physician lawsuits were filed against the companies seeking monetary damages on the same grounds. They cite claims not paid in full, interest due for untimely or slow payments and payments never made but rightfully due. The TMA lawsuits do not seek monetary damages; they ask that the court stop "these wrongful and financially punitive practices." Managed care has been under legal challenge in several states. Physicians' groups in New York and South Carolina have filed similar lawsuits this year. A federal lawsuit against major health care companies is pending in Florida by 600,000 doctors who claim they are routinely shortchanged on reimbursement claims through "institutionalized underpayments."