State Supreme Court Agrees With Cal. Medical Assoc: Says Physicians Cannot Be Arbitrarily Removed From Health Plan Panels
SAN FRANCISCO, May 10 /PRNewswire/ -- In a significant ruling for physicians and their patients, the California Supreme Court has ruled that managed care plans cannot arbitrarily terminate physicians from provider panels. The high court, in its decision on a 1992 case filed by an Orange County physician who was taken off a preferred-provider list by MetLife, said any such removals must be "both substantively rational and procedurally fair." In its 4-3 ruling Monday on Louis E. Potvin v. Metropolitan Life Insurance Co., the court relied heavily on an amicus brief submitted by the California Medical Association and the American Medical Association. Agreeing with CMA and AMA, the court declared that insurance companies, in making such arbitrary decisions, have tremendous powers to destroy medical practices. "If participation in managed care arrangements is a practical necessity for physicians generally, and if only a handful of health care entities have a virtual monopoly on managed care, removing individual physicians from preferred provider networks controlled by these entities could significantly impair those physicians' practice of medicine," the ruling said. The justices also found that there is a concern for the public interest because under managed care, patients often cannot choose their own doctors and are limited to those physicians who are on a health plan's panel. When a plan arbitrarily terminates a physician, the patient is arbitrarily deprived of a relationship with his or her physician. Louis E. Potvin, M.D., former president of the Orange County Medical Association and former chairman of the Obstetrics and Gynecology Department at Mission Regional Hospital, had been notified in 1992 that he would be removed from MetLife's preferred provider list. Dr. Potvin, now deceased, filed suit against MetLife in Los Angeles Superior Court, arguing that his removal from MetLife's provider list violated common law practices against "arbitrary expulsion." "This is a great victory for physicians and their patients," said CMA President Marie Kuffner, M.D. "The California Supreme Court has upheld a CMA tenet that basic fairness must be assured before decisions are made that adversely affect a physician's status -- and patients' access to their physicians in a managed care situation. Neither patients nor doctors should suffer needlessly." Dr. Potvin said, when filing the lawsuit, that MetLife had devastated his practice. Besides losing MetLife patients, he said he had been required to reveal his termination to other insurers and managed care entities, which then removed him from their preferred provider lists, further reducing his practice. Dr. Potvin's lead counsel Henry Fenton, J.D., is available for comment at 310-444-5244. To find the complete California Supreme Court decision in Potvin online, go to: www.courtinfo.ca.gov/opinions/. The California Medical Association represents more than 34,000 California physicians from all regions, modes of practice and medical specialties. CMA is dedicated to the health of all Californians.
SOURCE California Medical Association
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