A group of anesthesiologists at three New York hospitals has charged Aetna Life and Casualty Co. and its New York-area HMO with violating antitrust laws by forcing them to join the HMO.
Aetna flatly denies the charges and plans a vigorous defense.
The doctors' suit, filed Aug. 21 in U.S. District Court in New York, alleges Aetna threatened to terminate managed-care agreements with the three hospitals to coerce the 21 physicians to sign provider contracts this year. Those contracts compromised the doctors' ability to exercise independent medical judgment and the quality of medical treatment available to HMO enrollees, the suit charges.
"Instead of engaging in good-faith, arm's-length bargaining with prospective participating physicians on their merits, Aetna resorted to economic duress and threats of hospital contract termination to obtain unreasonable terms Aetna could not achieve in open negotiations," the plaintiffs contend.
Whitney Seymour Jr., a New York-based attorney representing the physicians, said the case is unique because it tests "a brand new theory." By forcing doctors to sign contracts and forfeit their independent medical judgment, Aetna restrained competition for anesthesia services provided to HMO enrollees, a violation of the Sherman Act, he said.
Seymour said the hospitals-Mercy Medical Center in Rockville Centre, North Shore University Hospital at Plainview (N.Y.) and South Nassau Communities Hospital in Ocean-side-"were almost the innocent victims" in the case because they depend on Aetna's business.
Angelo Dascoli, vice president of marketing for Aetna Health Plans of Metro New York, said "the suit has no merit whatsoever." He said officials are "perplexed" because the same contract has been used in the region since 1991, the only difference being the rates, which have been lowered. Furthermore, one of the three anesthesiology groups has contracted with Aetna since 1992, he said.
Dascoli added that Aetna has a multilevel appeals process that doctors may use to settle grievances, a process for amending contracts and an option to terminate a contract with 60 days' notice.
Aetna Health Plans of Metro New York covers 550,000 enrollees in managed-care plans and contracts with 11,000 physicians and 98 hospitals in New York, northern New Jersey and Fairfield County, Conn.
The doctors are seeking an unspecified amount of financial relief, an order to stop the HMO's alleged anti-competitive practices and an opportunity to renegotiate contracts.