United's fine mess: A way to alienate physicians

Many physicians are outraged about a policy sanctioning doctors for referrals to out-of-network labs.

Editorial. May 14, 2007.

It shouldn't have to take government action by each state for UnitedHealth Group to come to its senses on a policy that rightly has many physicians seething. We're talking about United's threat to issue fines to doctors who do not refer patients to network labs.

But at this point, with the edict on hold only in New Jersey, United still appears happily wedded to this turkey. If United executives keep on this tack, they will further damage an already often-strained relationship with physicians.

Many physicians are outraged that on March 1, United established a policy that fines them a minimum of $50 if they refer patients to out-of-network labs. There's more. Physicians also could face a change in eligibility in United's pay-for-performance and quality-rating programs or a decreased fee schedule. Doctors even risk being terminated from United's network.

Letters we have received from medical practices are blunt in expressing concerns and frustration. One asks: "How and why is the physician, a third party to the patient-insurance contract, the fall guy?" Another wants to know: "How much more can we do to police patients for the insurance companies? ... Would we be able to 'fine' the insurance company because their client didn't meet their financial obligation to us and we were losing money?"

Leaders of organized medicine have spoken out repeatedly against what is believed to be the first time an insurer has looked to punish physicians for sending patients out of network. Connecticut State Medical Society representatives met with their state attorney general to raise the question of whether United's policy was illegal. The American Medical Association and Iowa Medical Society sent letters to United voicing concerns. State medical society officials in Washington, Texas and Florida also are among those who questioned the policy.