Doctors Suing Insurers Over Denied Claims. (Growing Trend).

WASHINGTON -- Physicians are getting bolder about challenging insurers over delayed or denied health care claims.

Dr. John McMahan, an Illinois ear, nose, and throat physician, sued Employers Health Insurance Co., a subsidiary of Humana Inc., after the managed care organization began downcoding claims on outpatient office visits.

Although the difference in coding amounted to about $30 to $40 per claim, in the aggregate this can mean "savings of millions of dollars that are not being paid to providers," Jim Marks, an attorney with Harris, Kessler & Goldenstein in Chicago, who represented Dr. McMahan, told this newspaper.

In a settlement of the case last November, Dr. McMahan recovered all of the money owed on past claims, plus his attorney's fees and interest, the attorney said.

Mr. Marks said he's seeing more class action and individual suits by physicians seeking compensation that was denied due to downcoding, bundling, or other reasons.

Class action suits supported by state medical associations, specialty associations, and the American Medical Association, also are on the rise. Dr. Donald Palmisano, AMA's secretary-treasurer, predicted that "as long as insurance companies don't deliver on promises in their contacts," an increasing number of physicians will be filing lawsuits against the insurers--and winning more cases.

Susan Pisano, vice president for communications with the American Association of Health Plans, termed the increase in lawsuits against insurers "a troubling development."