Doctors Sue Aetna Over HMO Treatment Policy

A group of hospital anesthesiologists sued Aetna Life & Casualty Insurance Co. on Monday, alleging that the company threatened to get them fired unless they agreed to give up final say on patient care.

The federal court lawsuit says that when the doctors attempted to negotiate changes in their agreements with Aetna’s health maintenance organization, Aetna threatened to stop doing business with the hospitals where the anesthesiologists worked, thus putting their jobs in jeopardy.

The doctors claim the practice violates antitrust laws and is detrimental to patients enrolled in Aetna’s New York HMO.

The dispute illustrates the growing tension between doctors whose discretion over medical treatment for their patients is increasingly being restricted by cost-conscious managed health care companies such as HMOs.

Health maintenance organizations charge a flat fee for comprehensive health services. They restrain costs by limiting patients’ choice of doctors, hospitals and drugs and closely scrutinizing treatment. They are rapidly replacing traditional health insurance as a way to pay for medical care.

Many doctors have chafed at HMO restrictions on care, saying they interfere with sound medical decisions.

HMOs have appeals procedures to settle disagreements, but doctors have often complained that they are slanted in favor of cost cutting.

Monday’s suit, filed in U.S. District Court in New York, marks the first time doctors have sued to combat an insurer’s efforts to dictate the treatment doctors in managed-care groups can give, said the plaintiffs’ lawyers.

The suit was filed on behalf of 20 anesthesiologists at hospitals on suburban Long Island that negotiated contracts with Aetna Health Plans of New York Inc., Aetna’s New York-area HMO.

The doctors want an independent committee appointed to resolve medical disputes with Aetna. They also complained that Aetna wants the right to change the terms of its contracts with the doctors without their consent.

The doctors claim that when they complained to Aetna about its medical appeal process, the company threatened to stop sending patients to the hospitals. That would, in effect, bar the doctors from working at the hospitals and make it difficult for them to attract patients, the suit claims.

“Aetna was in effect saying, ‘We’ll see to it that you lose all your patients,’ ” said Whitney North Seymour Jr., an attorney at Brown & Seymour, a New York law firm. The suit seeks an injunction and compensatory damages.

Aetna denies the charges.

“There is absolutely no merit to the charges alleged in this suit,” said Sal Foti, a spokesman at Aetna. “Aetna categorically rejects the charge that any patient is endangered by its contracting practices. Aetna has a full and fair review process for medical treatment decisions affecting our members.”

Aetna is the nation’s third-largest health insurer and one of the largest operators of HMOs.

The anesthesiologists are on staff at Mercy Medical Center in Rockville Centre, N.Y.; North Shore University Hospital in Plainview, N.Y., and South Nassau Communities Hospital in Oceanside, N.Y.

Aetna has 20 days to file a motion or answer the complaint, Seymour said.