New York Lawsuit
New York doctors are filing a class-action suit against Oxford Health. It concerns a “take it or leave it” policy that Oxford and UnitedHealthcare have mandated. Both companies merged in 2004 and now are telling physicians that if they want to be in one plan, they also have to accept the other plan. If they do not agree, they would be terminated based on the “all-products” clause in the contract.
The Medical society and 11 individual physicians allege the rules violate antitrust laws. What happens is once a physician is in both plans, patients eventually get shifted into the lower paying inferior plan. If physicians do not accept this clause, they risk losing many of their patients.
The health plans are using their economic leverage with one plan to force physicians into accepting a plan they otherwise would not take. UnitedHealthcare and Oxford representatives declined to comment when interviewed by AMA news.
AMA policy opposes tying a physician’s membership in a managed care panel to that physician’s participation in any other managed care panel. AMA is continually working on legislation to prevent this from occurring.
The Medical society and 11 individual physicians allege the rules violate antitrust laws. What happens is once a physician is in both plans, patients eventually get shifted into the lower paying inferior plan. If physicians do not accept this clause, they risk losing many of their patients.
The health plans are using their economic leverage with one plan to force physicians into accepting a plan they otherwise would not take. UnitedHealthcare and Oxford representatives declined to comment when interviewed by AMA news.
AMA policy opposes tying a physician’s membership in a managed care panel to that physician’s participation in any other managed care panel. AMA is continually working on legislation to prevent this from occurring.
posted by Anonymous at 6:05 AM
6 Comments:
You are not any different than the rest of us.
" AMA is continually working on legislation to prevent this from occurring."
Using the government to get what you want.
Let the excuses begin.
If it already violates antitrust laws, then why is the AMA still working on legislation to prevent it?
It either violates current law, or it violates the law you want to have someday.
Which is it?
Of course, this would be a special interest group lobbying Congress--something most people oppose until it's their special interest group.
This is the american way and we are working within the system we have.
The legal challenge is up to the courts to decide.
Like any legal issue, there are attorneys on both sides believing their interpretation is correct. The courts and judges have to decide.
So...which side has "absolute truth" in its favor and which is only looking at it from a "relative" point of view?
Maybe I just don't get it but it seems to me that you are doing the same thing to your patients by refusing to accept their insurance coverage by having it your way or no way.
Its interesting that all we hear about on the news is how lawyers and malpractice cases are ruining health care. Yet, the docs never mind suing and using the courts when they're the ones harmed.
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