OPINIONConnecticut takes on managed careRecent lawsuits filed by Connecticut physicians are a striking reality check on physician frustration with managed care.Editorial. March 12, 2001. "The insurance capital of the nation" is what one almanac calls Connecticut, an apt description given the many insurers who are headquartered there. So it is fitting that Connecticut be the setting for perhaps the most sweeping litigation so far against tactics used by insurers in their managed care plans. Last month, the Connecticut State Medical Society filed unfair trade practice lawsuits against six managed care plans, including Aetna Inc., Cigna Corp., and Anthem Blue Cross and Blue Shield. At the same time, five physicians filed similar lawsuits. Last year, the Connecticut attorney general's office filed its own lawsuit on behalf of enrollees against four managed care plans, and it is also assisting the state medical society in this latest round of litigation. In addition, the AMA has expressed its strong support of these most recent cases. Certainly, managed care business practices have faced litigation before -- recent cases in California and Georgia are two notable examples -- but the Connecticut litigation is striking because it encompasses so many physician complaints about managed care, among them: arbitrary decisions overruling physician medical necessity decisions, downcoding claims, stonewalling on why claims were denied, flouting the state's prompt-payment law and forcing physicians into poor contracts. The context is the physician-insurer relationship, but inexorably tied to that is appropriate patient care and access to services.
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Copyright 2001 American Medical Association. All rights reserved.
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