North Carolina doctors sue UnitedHealthcare

For the second time this year, the state medical society targets an insurer.

By Robert Kazel, AMNews staff. June 7, 2004.

The North Carolina Medical Society has filed suit against UnitedHealthcare of North Carolina.

The lawsuit, filed May 14 in Wake County Superior Court, accuses United of some of the same improper business practices alleged in an earlier suit by the medical society against BlueCross BlueShield of North Carolina.

The medical society requests the judge's assistance in curbing practices the society says are "designed to delay, deny, impede and reduce lawful reimbursement."

Medical society leaders met in January with United executives to present their grievances, but the talks haven't produced results. "We were discussing things, but we were not resolving things," Robert Seligson, executive vice president and CEO of the NCMS.

Neither the suit against United nor the one against the Blues plan asks the court for monetary damages for doctors. "This isn't about money; it's about trying to solve problems," Seligson said.

The complaint accuses the plan of bundling and downcoding claims, failing to recognize modifiers on CPT codes and systematically denying payments to doctors for medically necessary claims. The society also says United continues to maintain an "all products" policy requiring that doctors participate in all or none of its product lines; that doctors are no longer able to get a coverage decision from the plan before performing a medical service; and that confidentiality clauses in contracts ban physicians from discussing payment for disputed claims with other doctors. (See correction.)