Doctor Puts Her Foot Down
$800 judgment from insurer won for what physician says is big problem.
It wasn't the modest cash award that most pleased Halderman. She said it was proving that CIGNA short-changed her for two minimally invasive biopsies performed in her office last year. She specializes in treating breast cancer patients.
For Halderman, it was the principle.
She said she spent months trying to get CIGNA to remedy the situation before going to court. And she said the effort made her angry: "It's a systemic, unethical business practice. It is a practice, not an error."
Wendell Potter, spokesman for CIGNA in Philadelphia, denied the insurer paid Halderman less than she deserved. He called it a difference of opinion in contract interpretation.
Many doctors say they're increasingly frustrated by what they see as insurance companies' failure to adhere to reimbursement agreements. A growing number of doctors, like Halderman, allege many of the nation's biggest insurers and HMOs have altered medical codes attached to procedures and diagnoses on claims to pay doctors less. The practice is called "down coding."
"The down-coding issue is a huge issue," said Karen Nikos, spokeswoman for the California Medical Association, which initiated litigation against insurers in 2000.
Down coding was cited in a federal antitrust lawsuit against 10 health plans alleging they violated the Racketeer Influenced and Corrupt Organizations Act, or RICO, by engaging in fraud and extortion in a common scheme to wrongfully deny payment to physicians.
The lawsuit, filed initially on behalf of doctors by the California Medical Association, was later transferred to U.S. District Court in Miami and consolidated with other lawsuits filed by doctors and medical associations against plans including CIGNA, Aetna, HealthNet and PacifiCare. Most of the plans, admitting no wrongdoing, agreed to settle last year, and doctors are continuing to submit claims to get paid.
Halderman said she believes CIGNA may have violated terms of its settlement agreement in the federal lawsuit, and she has complained about CIGNA's business practices to the California Department of Insurance.
State insurance spokesman Jason Kimbrough said the department is looking into her complaint.
Potter denied Halderman's down-coding allegation.
"We certainly don't think it's a violation of the RICO settlement," he said. He pointed out that the matter was a small-claims judgment and that CIGNA didn't put a local lawyer on the case.
Nevertheless, the judge thought that Halderman deserved $760.40 -- what the doctor said she was owed by CIGNA -- plus $40 in court fees.
Halderman said CIGNA had offered to settle for $2,000, but only if she agreed not to discuss the case publicly. She said she originally sought the amount because she wanted to donate it to a Selma-based cancer support group.
She said she refused the offer mostly because she wanted to be able to share the story.
"It was just so blatantly unjust," she said.
Potter said CIGNA tries to maintain good relationships with its doctors: "We're sorry that she [Halderman] is upset."
Halderman is making good on her promise to donate $2,000 -- the $800 CIGNA check she just received this week plus $1,200 more of her own money -- to Selma's Cancer Support Group. The local foundation helps cancer patients and their families with housekeeping and emotional support.
Halderman said she no longer takes CIGNA patients.