Class-action lawsuits against insurers: Settling for fair treatment

The power of organized medicine and the attention of individual physicians will ensure that settlements with managed care companies result in better conduct toward doctors.

Editorial. April 5, 2004.

One of the lead private attorneys handling physician class-action lawsuits against managed care companies calls settlements with Aetna and CIGNA "one of the greatest victories the medical societies have achieved for their patients and their physicians," and it's easy to see why.

The settlements put the companies' feet to the fire, setting medical necessity standards, forcing them to follow CPT guidelines and otherwise creating more open communication between the companies and physicians. The AMA, state, county and specialty societies worked on physicians' behalf, providing considerable leverage to get, so far, Aetna Inc. and CIGNA Corp. to promise to act fairly.

As any physician knows, leverage is key in negotiating a managed care contract, and until these settlements, the leverage seemingly always belonged to the health plan. As co-lead counsel Archie Lamb Jr. said, "The voice of those medical associations corroborated what individual physicians said for years, and it was a bullet hole between the eyes to those plans mocking and humiliating individual physicians who chose to step forward."

Organized medicine is involved in similar lawsuits and settlement discussions against companies such as Anthem Inc. and WellPoint Health Networks Inc., which recently finalized their merger to become the nation's largest plan. This provides the possibility that even more plans will see the light and decide to treat physicians with some measure of respect, ending the unfair business practices by managed care companies that have tainted their relationships with doctors.