May 2007

MDs taking aim at insurers

Chiropractors are not the only healthcare providers fighting managed-care organizations.

According to Medical Newswire, medical doctors are also taking aim at insurers. Recently, a group of doctors won a $1.5 million case against Florida insurer Blue Cross Blue Shield (BCBS, Health Options HMO). The attorney for the doctors said the insurer was refusing to pay pathologists for their professional services, although Florida law said HMOs must pay for these services when a member is admitted to a hospital.

By not paying, BCBS would have saved $4.1 annually. The company lost.

In New York City, a hospital has sued Health Insurance Plan (HIP) of Great New York for racketeering. The hospital alleges HIP unlawfully denied coverage to patients and, as a result, the hospital had to pick up the bill. The lawsuit questions HIP’s process for denying coverage.

The American Chiropractic Association is engaged in similar investigations. Currently, it is targeting reimbursement abuse by managed-care organizations. (See “ACA moves to halt MCO abuse.”).

Sources: Medical Newswire, www.medicalnewswire.com; Chiropractic Economics, www.chiroeco.com

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