Resistance builds against insurers' tiered networks

A lawsuit in Connecticut is the latest battle being waged on networks that doctors say use cost, not quality, data to rank them.

By Amy Lynn Sorrel, AMNews staff. Sept. 17, 2007.

Could someone fairly rate the quality of a restaurant based solely on the check they get at the end of the meal?

Most likely not. But some physicians say it's analogous to what health plans are doing when they crunch claims data to grade doctors' performance before placing them in a "preferred" network.

"The check has nothing to do with the meal. It's just a way to get paid," said Burton R. Rubin, MD, a family physician in Old Greenwich, Conn. "I could talk to a patient for 20 minutes about depression, and the bill is not going to reflect that. It ... doesn't give insurance companies an accurate description of the visit."

Dr. Rubin and 2,000 Fairfield County, Conn., doctors are suing UnitedHealthcare and Cigna to put a halt to what they see as flawed insurer ranking programs. The lawsuit, proposed as a class action, was filed July 26 by the Fairfield County Medical Assn. and nine individual doctors from Connecticut Family Orthopedics PC. The suit claims the networks defame physicians and deceive patients. Doctors also accuse the plans of breaching their contracts.

The physicians are not alone in their fight against so-called tiered networks, which purportedly drive patients to selected doctors as a way to curb health care costs. Battles have been waged coast to coast.

The Connecticut lawsuit is similar to one the Washington State Medical Assn. brought in September 2006 against Regence BlueShield over its "Select Network." The insurer called off the program indefinitely soon after the American Medical Association/State Medical Societies Litigation Center joined the suit in December 2006. In an August settlement, Regence agreed to involve the WSMA in developing quality measures.