The Connecticut State Medical Society today filed a federal lawsuit against the Indianapolis-based health insurer WellPoint Inc. accusing the company of conspiring to underpay physicians for out-of-network payments.
The case, which is related to the ongoing use of the Rocky Hill-based Ingenix database, seeks damages for Connecticut physicians who received allegedly artificially low payments from WellPoint for the reimbursement of out-of-network services.
The suit accuses WellPoint, the parent company of Anthem Blue Cross and Blue Shield in Connecticut, of colluding with UnitedHealth Group and other health insurers to deliberately underpay physicians, pushing the burden of excessive payment onto Connecticut patients.
The allegations are similar to those in lawsuits CSMS recently filed against Aetna Health Inc. and Cigna Corp. in February and include violations of the Employee Retirement Income Security Act of 1974, the Racketeer Influenced and Corrupt Organizations Act, and the Sherman Antitrust Act.
“Physicians should be paid appropriately for their services, whether the care provided is in-network or out-of-network,” said CSMS President William A. Handelman. “Anthem used faulty data in a scheme to underpay physicians. That forced them to spend significant time and resources appealing payments to be reimbursed. It’s another example why CSMS believes transparency is so important in discussions about health care reform.”
The American Medical Association and CSMS’ counterpart organizations in California, Georgia and North Carolina are plaintiffs with CSMS in the class-action lawsuit filed in Los Angeles.
A WellPoint spokesman e-mailed a statement in response to the suit.
“WellPoint is committed to providing appropriate reimbursement for out of network services,” the company said. “We are in the process of reviewing the complaint and are unable to comment further at this time.”
