AMA Joins Suit Against Aetna, Cigna Over Payment Data

February 11, 2009 11:24 am Published by

Readers of first read about this issue in 2000 as reprinted below:

Where Are The Doctors?

by Dr. Jeffrey Dorfman

(Published in Dentist Quarterly – The official publication of the New York County Dental Society – March 2000)

I attended the Bear Stearns 12th Annual Health Care Conference that was scheduled to run from September 15-17, 1999 at the Waldorf-Astoria Hotel in New York City. There were over 1200 registered attendees and over 150 speakers representing all kinds of healthcare companies. I was one of very few doctors who was invited to attend. I was asked to leave.

I was asked to leave because I asked two questions. Will insurance companies like Aetna and Wellpoint respect the request of the American Dental Association and stop using ‘usual, customary and reasonable (ucr)’ terminology in dealing with patients and instead use ‘maximum plan allowance.’ The reason for this request is that there is no such thing as a usual, customary and reasonable fee; there is tremendous variation of reimbursements for a given procedure even within the same insurance company based upon the specific policy purchased and premiums paid. To use such terminology raises distrust in the mind of the patient regarding their doctors fees.

I also asked the management of several publicly traded dental management service organizations if their growth strategies could avoid taking equity positions in dental practices through the legal subterfuge of ‘hard asset buyouts.’ This is because the American Dental Association believes that the welfare of patients is best considered when the ownership and control of dental practices remain with dentists, not investors.

These are legitimate questions that must be answered if doctors are to become involved in the evolution of healthcare delivery in our country. Investment bankers and their investors should not consider doctors merely a variable cost in healthcare and in need of paternalistic employment. We should be considered equal partners and invited to attend these conferences. Healthcare is much more than the pathetic representation of revenues and income growth as shown at this conference.

Read the Wall Street Journal article.

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This post was written by Dr. Jeffrey Dorfman