Connecticut Doctors File Suit
In Connecticut, 16 doctors recently gained court approval to press a similar class action suit against Anthem Blue Cross Blue Shield. They claim the company arbitrarily changes reimbursement rates without notice and exploits doctors’ fears of not being paid in order to influence them to limit patient care to keep medical costs down.
Earlier this year the 7,000-member Connecticut State Medical Society filed a suit alleging that seven of the state’s top HMOs engage in wrongful practices.
Dentists File Suit
The American Dental Association brought a class action suit August 16 against Aetna, in the U.S. District Court for Northern Illinois, charging the company with breach of contract and unlawful interference with the dentist-patient relationship. Aetna is the third-largest provider of dental insurance in the country. The ADA suit accuses the firm of violating its contract with subscribers by failing to pay the actual charges for professional services by non-plan providers, without furnishing appropriate data to substantiate a lower payment.
Robert M. Anderson, president of the dentists association, said that amounts to trade libel, and has seriously undermined the trust between dentists and their patients.
Dentists have lost long-standing patients as a result, he said.
States Crack Down
Some state regulatory agencies are getting tough with health insurance companies. According to the consumer-oriented insurance news Internet site insure.com, actions taken recently include:
· In Texas, the United Wisconsin Life Insurance Co. was fined $35,000 and ordered to pay an estimated $710,000 in restitution for overcharging on small employer health insurance plans. The company agreed to pay the money in two installments, but did not admit that it had violated either the Texas Insurance Code or the rules of the Texas Department of Insurance.
· Also in Texas, the state Attorney General has brought a suit against Conseco Senior Health Insurance Co. and American Travellers Life Insurance Co., which Conseco bought in 1996, charging that they used deceptive insurance rate schemes to persuade more than 10,000 older Texans to buy long term care policies between 1992 and 1999.
· And in Texas again, Commissioner Jose Montemayor has slapped seventeen health insurers with fines totaling $9.2 million for violating a state law that requires claims to be paid within 45 days. The Texas Department of Insurance said the fines were the result of numerous “justified” complaints from doctors and other healthcare providers about “thousands of clean claims” that were paid after the 45-day time limit had passed. The insurers agreed to pay the fines, but did not admit to doing anything wrong. Gary E. Goldstein, M.D., chief executive officer for Humana in Central Texas, said the real problem is that too many doctors rely on submitting paper claims, which prevents them from getting paid “with optimum speed and efficiency.”
· California state insurance regulators recently seized the financially-strapped Watts Health Foundation, an HMO that covers 96,000 mostly low-income and elderly people in San Bernardino, Orange, and Los Angeles counties. The state Department of Managed Health Care said it will oversee the operations of the company, pay outstanding claims to healthcare providers, and ensure that the plan’s members do not experience any disruption to their healthcare services.
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