Docs sue Aetna, Cigna over low payments for services
Wednesday, February 11th, 2009
A group of doctors associations are suing a pair of health-insurance companies for not paying New Jersey doctors enough for the care they provide to out-of-network patients. The American Medical Association joined doctors groups in New Jersey and four other states in accusing Aetna and Cigna of cheating the doctors and patients alike. WHYY's Mary Fuchs reports from Trenton.
Listen:
Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.
Transcript:
Aetna is accused of using company software to shortchange both doctors and patients when people go out of network for health coverage. Larry Downes, general counsel for the Medical Society of New Jersey, says it's a big deal for the state since a lot of doctors here don't participate in health plans.
Downes: We do know that health insurance companies in New Jersey process millions of transactions annually and a certain portion of those transactions have resulted in underpayments to physicians and patients in New Jersey and this suit is going to seek to remedy that situation.
Downes says the goal of this particular lawsuit is to pay back doctors and not patients. An Aetna spokesperson says if they are required to reimburse all out of network services, the end result will be higher premiums for everyone.
Additional Information:
The doctors groups and The American Medical Association accuse the companies of using a software program called Ingenix to underpay doctors and patients.
Downes: That database is what's used by many insurers to calculate those out of network rates. The data that's gone in and the way its been analyzed and computed is in a faulty way. It actually works to underpay doctors for their services.
Cynthia Michener is a spokesperson for Aetna Healthcare. She says the company can't fully reimburse both doctors and patients who were not paid enough for out-of-network services.
Michener: If everyone believes they are entitled to additional services, the health care system will bear the burden and increase costs for everyone.
New York Attorney General Andrew Cuomo's investigation into the Ingenix database found that it allowed health plans to underpay physicians in reimbursements on medical bills. New York's medical society joined the lawsuit in New Jersey.
New York has reached agreements with several insurers over this issue: http://www.newsinferno.com/archives/4751#more-4751
The remark by Cigna's public relations person saying "………… the company can’t fully reimburse both doctors and patients who were not paid enough for out-of-network services." is utter contempt of patients. Cigna should have realized long ago this was a problem instead of relying on lawyers to get them out of trouble. Its like the auto companies in the 1970 reacting to Congressional mandates on MPG, they hired lawyers and lobbists while the Japanese auto manufacturers responded by hiring engineers. You know who won that round. Perhaps they should take back (claw back) all their executive's bonuses from 1998 as a way of funding this disrespectful practice. Also, do the same with board members compensations. It doesn't matter that it won't be enough, its the principle that matters. Thisexcuse to get out of what was promised should not be tolerated even for a second.