Connecticut medical society sues six managed care plans

Explaining that attempts at negotiation went nowhere, the group now hopes the legal system can make health plans change the way they do business.

By Julie A. Jacob, AMNews staff. March 5, 2001.

The Connecticut State Medical Society has filed civil lawsuits against six managed care plans in the state in an attempt to force the health plans to change business practices that the state society contends violate the state's unfair trade practices law.

Said Donald Timmerman, MD, CSMS president, "We want to seriously convey in no uncertain terms that managed care must take the concerns and needs of physicians seriously. ... Physicians have been so bruised and battered that they have been pushed to the limits of human tolerance."

The CSMS on Feb. 14 served notice to the six managed care companies: Aetna Inc., Anthem Blue Cross Blue Shield, Cigna Corp., ConnectiCare Inc., Oxford Health Plan and Physician Health Services. Under Connecticut law, the defendants are served notice first, then the complaints are filed about 10 days later, said Jim Hartley, an attorney with Drubner, Hartley, O'Connor and Mengacci in Waterbury, Conn., who is handling the medical society's suit. The complaint was scheduled to be filed in state superior courts in New Haven and Danbury, said Hartley, but likely will later be consolidated at one state court.

The complaint alleges that the health plans arbitrarily overrule physician decisions on medically necessary care, arbitrarily downcode claims, fail to explain why claims are denied, improperly use computer programs that automatically downcode or deny claims, fail to properly staff utilization review departments, pay claims late and fail to pay interest on late claims, systematically breach the terms of their contracts with doctors and force them to enter into nonnegotiable contracts that interfere with the physician-patient relationship. [...]