AMA tackles out-of-network fines by health plans

The AMA has decided to go to war against insurers who impose fines on doctors if patients use out-of-network labs. While the dispute began with UnitedHealth Group, which has set plans in motion to impose such fines, the AMA is concerned enough about the trend that it is instituting a broader campaign opposing the institution of such fines by any insurer. The group is supporting pending federal legislation which would ban such fines.

In the meantime, UnitedHealth has been fighting back, at least in the court of public opinion. In their defense, execs are noting that despite the furor, the plan hasn't actually imposed any penalties yet. UnitedHealth says that it would only impose the fine if physicians "knowingly and repeatedly" refer to non-network labs. Even in that case, the plan would first reach out to the doctor in question and discuss their reasons for making such referrals, a plan spokesman said.

The question is, why is UnitedHealth proposing to penalize doctors? Wouldn't current trends in consumer-driven health suggest that the patients should end up picking up some of these costs? Seems like an odd way to handle physician relations.

To find out more about AMA's campaign:
- read this Chicago Tribune article

Post a comment