N.Y. medical society sues six insurers

The Medical Society of the State of New York sues six insurance companies with managed care plans in the state.

By Tanya Albert, AMNews staff. Sept. 3, 2001.

Physicians of the Medical Society of the State of New York have joined the growing ranks filing suit against managed care firms that challenge the way the companies do business.

MSSNY, which represents 27,000 physicians, filed separate lawsuits in August against each of the six largest insurers in the state: Aetna, Cigna, Empire Blue Cross/Blue Shield, Excellus, Oxford and United HealthCare.

The suits claim the companies breached contracts with physicians by arbitrarily denying medically necessary care, capriciously reducing reimbursement claims and subjectively downcoding and bundling claims. The suits also accuse the companies of using computer programs to deny claims based on arbitrary guidelines.

"We need to finally get the insurers to take the charges seriously," said MSSNY President Robert Bonvino, MD. "It really is sad that we have to go to the court system to make HMOs live up to their contract. Unfortunately, there's no other way."

Paul Macielak, New York Health Plan Assn. president, said the lawsuits weren't about patients and that they instead aimed to enrich doctors' pocketbooks.

"If the medical society and its doctors are truly concerned about patient care, they would use their considerable resources on efforts to improve overall quality of care and reduce medical errors," he said in a prepared statement. [...]