Medical group calls for antitrust probe of insurer

Medical group calls for antitrust probe of insurer | Insurance Business America

Medical group calls for antitrust probe of insurer

The American Society of Anesthesiologists (ASA) has called on the Justice Department’s Antitrust Division to investigate the conduct of an insurer it says is engaging in anti-competitive conduct.

The ASA has called for an investigation into the conduct of UnitedHealth Group (UHG), which the organization claims is terminating participating provider agreements with anesthesia practices at a high rate.

“High-quality, affordable anesthesia care is crucial for patient care,” said Dr. Beverly K. Philip, ASA president. “UnitedHealth Group’s terminations of participating provider agreements with ASA member anesthesia practices are harming competition by forcing willing anesthesia practices ‘out of network.’ This results in higher out-of-pocket costs and reduced numbers of in-network anesthesiologists for patients, especially where UnitedHealth Group can do this to favor its own employed anesthesiologists.”

In a letter to the acting assistant attorney general, ASA said that since UHG is vertically integrated, it has both the ability and the incentive to leverage its UnitedHealthcare (UHC) subsidiary’s status as an insurer, including to unfairly favor Optum, UHG’s healthcare-provider subsidiary, and its own anesthesiologists. 

ASA also said in the letter that UHC also operates as a third-party administrator for employer-sponsored health plans, and, under the guise of a “shared savings” program, has an incentive to reduce the number of in-network anesthesiologists in order to increase UHG’s profits while increasing the fees and costs passed on to employers.

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ASA asserted that anesthesiologists have been harmed by being denied access to UHG’s members – especially in areas where UHG members represent “a substantial share of commercially insured patients.”

“The participating provider agreements that have been terminated were negotiated at arm’s length and mutually beneficial,” Philip said. “It is regrettable that UHG is taking steps to reduce access to in-network anesthesiologists and harming patients, employers and anesthesiologists in the process.”