MedChi sues insurer over conditions placed on Md. physicians

Suit claims UnitedHealth illegally requires doctors to accept all its plans

August 19, 2005|By M. William Salganik | M. William Salganik,SUN STAFF

The state medical society yesterday filed suit against UnitedHealth Group, the Minnesota health insurance giant, charging that United is illegally requiring doctors to contract with all of its health plans in order to contract with any of them.

T. Michael Preston, executive director of MedChi, the 7,000- member medical society, said the freedom to choose among different plans offered by an insurer was "a major issue for physicians" and was guaranteed under a state law passed in 2000.

The suit was filed in Circuit Court in Montgomery County.

Steven Matthews, a spokesman for UnitedHealth, said the company's policy is not to comment on litigation.

Separate contracts

The dispute concerns the system under which insurers contract with doctors to be in their network of health care providers. Often, doctors are offered separate contracts by an insurer for HMOs, preferred provider organizations (PPOs) and other types of insurance policies - a practice MedChi says is required in Maryland.

Members of a health plan receive reduced or no benefits if they go to doctors who don't have contracts with the insurer's network, so the contracting practices can affect members' choice of physicians.

`Cramming down'

If United continues its "all-or-nothing" approach to contracting, which doctors call "cramming down," Preston said, some doctors might drop all United plans rather than sign up for all. That would force some of their patients to change doctors. He said he wasn't aware of any cases of that happening yet.

United is the second in market share among Maryland insurers, after CareFirst BlueCross BlueShield, since it acquired Rockville-based Mid Atlantic Medical Services Inc. (MAMSI) early last year. It now operates MAMSI as a subsidiary.

Dr. Scott Maurer, who practices in internal medicine in Glenwood, Howard County, and is one of the plaintiffs in the case, said he has been contracting with MAMSI and United's PPO plans and with United's HMO. However, he said, he has chosen not to participate in MAMSI's HMO network because of "the inordinate amount of paperwork and the impersonal environment for the patient."

He said he had been told he needed to sign up for MAMSI's HMO or drop United's HMO, which would cause him to lose 98 patients. He said United had not given him a firm deadline but that the change would happen this fall.

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