DOCTORS ARE IN, PATIENTS OUT

September 30, 2002
You win some, you lose some. Last week, doctors won, patients lost. A federal judge in Miami refused to grant class-action status to a suit representing 145 million subscribers to health maintenance organization (HMO) insurance plans.

But U.S. District Judge Federico Moreno tentatively granted class-action status to a suit by about 600,000 doctors against Aetna, Cigna, Humana, Foundation Health Systems, Prudential and United Healthcare, among others.

The doctors claim that the HMOs routinely put them through costly and time-consuming exercises that make it unrewarding to challenge payments for medical procedures. The insurers say they are simply trying to control runaway health costs.

The patients' suit claimed that the HMOs had deceived its policyholders by deceiving them into thinking they were subscribing to high-quality health insurance when in fact they were getting second-rate policies with limited coverage.

Moreno said the immense size of the class would have made the suit unmanageable and he said the subscribers had failed to prove that the companies had acted together in deceiving their subscribers.

Thus, Moreno rejected the patients' contention that the insurance companies had basically engaged in racketeering by using organized fraud and deception.

The doctors' case will go to trial next spring.

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