A consortium representing 25,000 doctors said yesterday it is stepping up legal action against the Oxford insurance company to claim more than $140 million in unpaid fees.
The action comes after more than six months of fruitless negotiations in the dispute with New York s largest HMO, according to the New York County Medical Society..
The society together with 13 other doctors groups has accused the insurer of "a pattern of delays, den-ials and detours from acceptable practice" in failing to pay doctors for as long as a year after they saw Ox-ford patients.
The Norwalk Conn.-based insur-er has called the $140 million figure a "substantial overstatement." Oxford did not immediately return a call for comment yesterday.
The HMO has said it pays most of its doctor bills within 30 days. The doctors said the company paid only after a long wait or prodding from them.
The agreement they had signed with Oxford forbids them from tak-ing the insurer to court. Instead, the medical societies have now filed $1.5 million in claims on behalf of an-other 35 physicians, added to 500 doctors who already have signed no-tices of intent to arbitrate; more fil-ings are to be made on an ongoing basis.
Oxford "continues to spin in cir-cles like a rudderless ship," said Dr Elizabeth Almeyda, president of the New York County Medical Society. "There are too many reports from doctors and patients who are being hurt day-in and day-out by arbitrar-ily denied claims, delayed payments and health-care services not autho-rized."
The doctors first started their ac-tions against Oxford in February but agreed on a moratorium on any new arbitration pending the out-come of the negotiations.
"Six months down the road, doc-tors are still hurting and Oxford s feet aren t even dragging - they're frozen," said Jeffrey Ruggiero of Lester Schwab Katz & Dwyer, one of two legal firms retained by the soci-eties.
Oxford was already fines $3 mil-lion by New York insurance regu-lators in December over the HMO's inability to pay claims on time and other irregularities, the largest fine ever levied by the New York regulators against. a health insurer.
The company has said its computerized-billing system delayed payment to doctors and impeded collection of premiums from pa-tients. more