Conn. Doctors Sue UnitedHealth Group Over ‘Inferior’ Plan Requirement

Four Connecticut doctors have filed a lawsuit accusing the nation’s largest health insurer of using anticompetitive practices to force them into a substandard health insurance network.

The doctors filed the lawsuit in Bridgeport Superior Court against UnitedHealth Group and Oxford Health Plans, which merged last year in a deal worth about $4.9 billion.

The doctors contend the company is requiring them to accept an inferior plan offered by Oxford if they wish to remain in United’s network. The Oxford plan pays lower fees to doctors and involves long waits on phones and difficulty getting approval for medical procedures, the doctors say.

“In short, Oxford and United are using the combined economic muscle created by their recent merger to extract significant financial concessions from physicians and to impose Herculean administrative burdens upon them,” the lawsuit states. “Indeed, if Oxford and United are not stopped in their tracks now, it will only be a matter of time before they carry out the next step of their master plan to impose unreasonably low fee schedules upon physicians throughout the state regardless of the health plan in which they participate as medical providers.”

Maria Shydlo, a spokeswoman for Oxford, said she could not comment on pending litigation. But she said the company has consulted with regulators.

“We believe the network integration is appropriate,” Shydlo said.

The merger offers doctors more access to patients and provides patients with access to a broader network of doctors, Shydlo said. The company has not had many complaints about its approval process, she said.

Oxford, based in Trumbull, provided health insurance services for approximately 1.5 million people, mostly in New York City, northern New Jersey and southern Connecticut. UnitedHealth, based in Minneapolis, served about 20.2 million customers across the nation.

The lawsuit was filed by Fairfield County doctors Donald J. Austrian, Francis A. Garofolo, Kenneth A. Miller, and Evangelos D. Xistris and seeks class-action status on behalf of hundreds and possibly thousands of doctors.

They are seeking monetary damage and an order that would prevent the company from requiring the doctors to accept both networks as a package. The doctors also want the company to keep approval offices open at all times and reduce hold times to 10 minutes.

Most doctors cannot afford to replace their United patient base, and are “railroaded” into becoming an Oxford provider, the suit contends.

The practice has been banned in seven states, Arkansas, Florida, Indiana, Kentucky, Maryland, Massachusetts and Virginia, according to the lawsuit. The U.S. Department of Justice and the American Medical Association also has challenged the practice, the doctors say.

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