Health plan class-action settlements: Trust, without the expiration date

Insurers must commit -- for the long term -- to an open and honest relationship with doctors.

Editorial. June 4, 2007.

The BlueCross BlueShield Assn. and more than 30 affiliated plans and subsidiaries have agreed to settle physicians' claims of improper payment practices. Now only UnitedHealth Group and Coventry Health Care remain as defendants in class-action litigation that has successfully forced most big health insurers to be more open and fair in how they deal with doctors.

The Blues settlement roughly follows the pattern of the ones before it, including revised claims-payment procedures, independent review boards to arbitrate billing disputes and a payout. In this case, it was $176 million in physician compensation and attorneys' fees. And it has one more common feature, this one less welcome -- an end date.

As is common in class-action litigation, the settlements last for only a limited time, usually three to five years. Cigna's settlement expires in September. Aetna's expires next year. Given the rocky history between health plans and physicians -- hence the settlements in the first place -- doctors have good reason to be wary of a time limit on health plans' improved behavior.

That is why it is a must that health plans, as the AMA has put it, should voluntarily and permanently establish business practices that permit fair and open dialogue with physicians.