Wilton Doctor Part of Huge Health Care Lawsuit

The state's largest medical group has taken a stand against one of the largest players in the insurance capital of the world.

The Connecticut State Medical Society filed an appeal in New Britain Superior Court to overturn the State Insurance Department's recent approval of an insurance company merger. Wilton resident Dr. Kathleen A. LaVorgna, a surgeon at Norwalk Hospital and Dr. Michael M. Deren of New London also filed with CSMS.

Last month, the DOI approved UnitedHealth Group's purchase of Health Net. United purchased "renewal rights" for Health Net's commercial customers. It can now set new premiums without regulatory oversight.

It can also avoid offering coverage to businesses that have higher employee medical claims. More than 220,000 Connecticut patients will be affected, said CSMS.

The fact that this happened in the insurance capital is a slap in the face said LaVorgna.

"The Department of Insurance needs to consider the ramifications of its decision on the patients of Connecticut, not just on the insurers doing business in Connecticut," said LaVorgna.  "I believe that the DOI did not consider the impact of this acquisition on physicians or their patients."

If, for example, a hypothetical copy shop in Wilton provides health care for its employees through Health Net and their policy is slated for renewal in May, United could decide to either raise rates or drop people all together if it decides the copy shop employees are sicker than other policyholders.

This merger could leave thousands of people without insurance, said CSMS. The purchase will also limit access to healthcare, reduce reimbursements to physicians, and potentially violate privacy laws, said LaVorgna.

In addition, CSMS maintains the DOI didn't properly review its testimony, or that of the American Medical Association and the Physicians Advocacy Institute when they testified at a hearing before the Connecticut Department of Insurance last month. The medical societies were denied the chance to cross-examine witnesses, said CSMS.

The Department of Insurance said its lawyers are reviewing the lawsuit.

Though DOI approved the transaction, though the Connecticut Attorney General and the U.S. Department of Justice are investigating. Those outcomes are pending.

Because United now has access to all of Health Net's records there are potential patient privacy violations, as well.  These will be addressed through state and federal processes, said CSMS.

As far as AMA and CSMS knows, this is the first transaction of its kind.

LaVorgna views the fact that this happened in the insurance capital of the country viewed as offensive.

"The basis of health care rests with the doctor-patient relationship.  This relationship is consistently disturbed, distorted and even destroyed when insurers merge," said LaVorgna. "I have practiced in this state for the last 20 years. With each merger, my ability to provide appropriate care has been affected. And not for the better."