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Landmark Lawsuit Against HMOs
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Business New Haven
2/19/2001
By: BNH
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NEW HAVEN- In an apparently unprecedented legal action, the Connecticut State Medical Society (CSMS) and state Attorney General Richard Blumenthal on St. Valentine's Day filed separate actions on behalf of CSMA's 7,000 physicians against Connecticut's six largest managed-care companies. The suits allege that the health plans - Oxford, Cigna, Aetna, ConnectiCare, Anthem Blue Cross & Blue Shield and Physicians Health Services - are engaged in arbitrary denial of medically necessary care, arbitrary downcoding of claims, fail to properly staff utilization and clinical departments and engage in improper claims review by employing computerized programs that automatically reduce or deny claims.
Said CSMS President Donald Timmerman, M.D., “These lawsuits take direct aim at health-plan policies and practices that place critical medical-care decisions in the hands of insurance-company bureaucrats instead of the professional judgment and expertise of physicians.”
Comment from representatives of the six respondents to the suit was not available at press time.
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