N.Y. AG Cuomo Takes Issue with Health Insurers’ Physician Rankings

August 17, 2007

New York Attorney General Andrew M. Cuomo has warned two major health insurers, Aetna and Cigna Healthcare, that their physician ranking programs, as currently designed, “are likely to confuse or even deceive consumers.”

In letters to the two insurers, Cuomo expressed concern about the design of the programs and requested a full justification for them.

“Transparency and accurate information are essential when consumers make healthcare decisions,” said Cuomo. “We will ensure that insurance companies are not obscuring important facts at the consumers’ expense.”

Aetna and Cigna Healthcare have significant enrollments in counties across New York State.

Health insurance companies create physician ranking programs to recommend certain primary care physicians and specialists to consumers.

In his letter, the attorney general cites what could be problems in the design of the physician ranking programs created by Aetna and Cigna Healthcare: “the rankings are based on claims data, which is well-known to carry several significant risks of error when used to rank individual physicians; the insurers do not disclose the accuracy rate of their rankings; and insurers have a profit motive to recommend doctors who cost less, not necessarily those who are most qualified.”

He also expresses concern that inaccurate physician ranking programs may cause financial harm to consumers. “Some employers steer employees to the doctors preferred by the insurer by lowering copayments or deductibles. Consequently, employees who choose not go to the preferred doctors could pay more,” he noted.

In July, Cuomo instruced UnitedHealthcare not to introduce its physician ranking program in the state without his prior approval. He said his office and UnitedHealthcare are currently involved in discussions about that program, which was scheduled to be introduced in October 2007.

Source: New York Attorney General
www.oag.state.ny.us

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