Doctors Say UnitedHealth Is Threatening Fines

NEW YORK CITY (AP) — Doctors say UnitedHealth Group Inc is threatening to fine them over something they can’t control — patients’ behavior.

Beginning March 1, UnitedHealth said it could fine a doctor $50 if a patient has tests done in facilities besides Laboratory Corp of America or other labs that the company has selected. Doctors with patients who go out of network could also be subject to lower reimbursement and to exclusion from United’s network.

The American Medical Association said this is the first time a doctor could be financially punished for a patient’s behavior. AMA trustee Dr James Rohack said doctors can refer patients to in-network labs but patients may choose to go elsewhere because of convenience or preference.

Tyler Mason, a UnitedHealth spokesman, said the policy is not intended to punish doctors for patients’ choices but to remind doctors to refer patients to labs in the network. He said the insurer wouldn’t fine doctors if a patient defies their referrals and selects a nonnetwork lab.

“The fine scenario is highly unlikely,” Mr Mason said.

Mr Mason said he understood how doctors could be upset by the notion of fines but added that all contracts subject physicians to smaller reimbursements and possible expulsion for failing to abide by the terms. He said patients’ expenses for going out of network would depend on their individual policies.

Last October, UnitedHealth announced that effective January 1, 2007, its major national carrier would be Lab Corp instead of Quest Diagnostics Inc and began communicating with physicians about the switch. The fines don’t go into effect until next month to give both doctors and patients an opportunity to adjust to the change.

Some physicians say the size of the new network is too small. Matthew Katz, executive director of the Connecticut State Medical Society, said that while UnitedHealth has been adding labs in the state, there are still many gaps. He said the issue was raised with Connecticut’s attorney general and the state insurance commissioner, but neither has responded.

Dr Rohack remains skeptical about UnitedHealth’s pledge to work with doctors to avoid fines and other financial penalties. He said the current policy is more about saving UnitedHealth money than providing the best coverage for patients.

“They [United] always say they are going to play nice in the sandbox,” Dr Rohack said. “But if the stock price starts to get shaky, they don’t place nice anymore.”