The health insurance industry is facing a barrage of lawsuits from doctors and dentists, and some states — notably Texas — have been cracking down hard on companies.
The New York Medical Society is suing Cigna, Aetna, Empire Blue Cross, Oxford, Excellus, and United Healthcare, charging that they have harmed both physicians and patients by denying medically necessary care.
Filed August 15 in the Albany, N.Y., Supreme Court, the suit accuses the companies of reducing reimbursements and denying claims based on arbitrary guidelines, and charges that their staffing is inadequate to ensure that all claims are processed properly.
Robert Bonvino, M.D., president of the 27,000-member society, told the Albany Times-Union that the companies have displayed an utter disregard for patients and doctors. It is a sad comment on the way these insurance carriers conduct business that we have to go to the court system to force them to live up to their obligations, he said.
Several individual New York doctors have also filed class action suits against the six companies, asking that the firms be barred from continuing the policies and practices to which the society objects, and seeking unspecified money damages.
Though company officials have yet to review the New York Medical Society lawsuit, Oxford spokeswoman Maria Shydlo told Reuters Health that Oxford believed the suit was completely unfounded and without merit. She said that Oxford pays its claims based on CPT codes, on average, in less than 2 weeks. It now only receives referrals electronically and Oxford eliminated its “concurrent review” practice, in which claims could be denied retrospectively, 2 years ago.
Like Oxford, Aetna denied the charges in the suit in the present tense, asserting it had streamlined its referral process, increased contract flexibility and significantly improved claims turnaround time in “recent months” according to Reuters Health. Aetna also said that the suit was similar to others filed against insurers in the past 2 years.
“We are disappointed that the Society has chosen to ignore these concrete [claims processing] changes, and decided instead to pursue costly and time-consuming litigation,” Aetna said in a statement.
Empire Blue Cross & Blue Shield said that it believed the suit was “without merit,” based on what the society had posted on its Web site. According to Reuters Health, a spokeswoman said that it had one of the best reimbursement records in the industry, paying 98% of “clean claims” within 14 days.
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