Connecticut groups sue to find out Medicaid HMO physician pay rates

The insurers say physician reimbursement is confidential business information.

By Amy Lynn Sorrel, AMNews staff. Sept. 18, 2006.

The question of whether the rates Medicaid HMOs pay doctors is public information has fueled an ongoing legal battle in Connecticut among the four state-contracted health plans, state officials and patient advocates.

The case was sparked in 2004 when a group of New Haven-based clinics noticed that their patients had problems getting appointments with cardiology and gastroenterology specialists. The clinics suspected that one reason for the difficulties was that Anthem Blue Cross & Blue Shield, Health Net, WellCare and Community Health Network of Connecticut Inc. were paying low reimbursement rates to physicians, and as a result doctors were taking fewer Medicaid cases.

"These were patients with significant symptoms, not patients seeking a check-up," said Kari A. Hartwig, PhD, an assistant clinical professor at the Yale School of Public Health. She sought the fee information under the state Freedom of Information Act from the Connecticut Dept. of Social Services on behalf of the Greater New Haven Partnership for a Healthy Community. The coalition includes the Yale School of Public Health, the New Haven Health Dept., Yale-New Haven Hospital, the Hospital of Saint Raphael, Fair Haven Community Health Center and Hill Health Center.

When the Dept. of Social Services declined her request, Dr. Hartwig, joined by a number of other legal aid groups representing Medicaid patients, filed a Freedom of Information Act complaint.

"The Legislature needs to know if these programs need additional funding, or alternatively, if the [HMOs] are keeping too much money for themselves," said Daniel J. Klau, Dr. Hartwig's attorney.