Washington state physicians sue plans over business practices

The doctors become the latest in a growing number of groups to file grievances against managed care companies -- in this case, Regence BlueShield and Premera Blue Cross -- in state court.

By Tanya Albert, AMNews staff. April 15, 2002.

Two groups of Washington physicians are turning to state court for relief from what they contend are health plans' unfair payment practices.

Their proposed class action lawsuits accuse the managed care companies of systematically bundling and downcoding CPT codes on legitimate physician claims. The two complaints also allege that the companies delay and deny claims in ways that violate Washington prompt-pay laws.

"We believe we should be paid fairly and according to our contracts for the medical services we provide," said Cliff Robertson, MD, chief medical officer for Franciscan Medical Group in Pierce County, Wash.

The 72-physician group joined with seven orthopedic surgeons from Tacoma Orthopaedic Surgeons Inc. in March to file separate lawsuits, one against Regence BlueShield and the Regence Group and a second against Premera Blue Cross and PremeraFirst Inc. During pretrial hearings, a judge will rule on whether the cases will go forward as class action suits.

The complaints also claim that the companies breached contracts, violated the Washington Consumer Protection Act, breached the covenant of good faith and fair dealing, and broke state laws that prohibit criminal profiteering activity.

Dr. Robertson said that since the lawsuits were filed, numerous physician offices in the county and from across the state have called to say that they have experienced similar problems. "They are happy we were moving forward with a lawsuit," he said.

Doctors said they've tried to work with health plans to resolve problems outside the courtroom but that the talks haven't been successful. [...]